Role of liver transplantation in the management of metastatic neuroendocrine tumors

Neuroendocrine tumors metastatic to the liver: How to select patients for liver transplantation?

“…Over the last two decades, the established strategy for the management of patients with metastatic NET takes into account the option of OLT as a salvage therapy, with unfortunately disappointing results as a consequence of suboptimal patient selection (Table 3) [19,[22][23][24][25][26][27][28]. As for other tumors amenable to surgical management, a modern approach to the treatment of NET has to consider multimodal approach carried out by a multidisciplinary team, including oncologists, hepatologists, nuclear medicine experts, interventional radiologists, psychologists, etc.…”

From biology to clinical experience: evolution in the knowledge of neuroendocrine tumours

“…This study has in fact highlighted that the simultaneous presence of Ki67 and E-cadherin (high levels of Ki67 and abnormal expression of E-cadherin) results in significant increases of patients' survival and rate of relapses [40]. Table 4 reports the results achieved with liver transplantation in different experiences [31][32][33][34][35][36][37][38][39].…”

“…However, if on one hand, surgery offers undeniable advantages, on the other hand it is strongly limited by the incidence of relapses at intra-and extrahepatic level which at 5 years account for about 59% [30]. According to the ''Milano criteria'' drawn up on the basis of the experience gathered at the Istituto Nazionale Tumori -Milan, liver transplantation should be limited to selected patients with good chances of cure (Table 3) [31][32][33][34][35][36][37][38][39].…”

Treatment of endocrine pancreatic tumors

“…In a more recent publication a Spanish group has reported on four patients with neuroendocrine tumors originating from the pancreas and one from the small bowel undergoing liver transplantation [31]. Two patients are alive and free of tumor 3 and 6 years after transplantation whereas 3 died early.…”