Surgical therapy of neuroendocrine neoplasm with hepatic metastasis: patient selection and prognosis

Abstract

Surgical resection of hepatic NEN metastases can reduce symptoms and improve the survival in selected patients with a Ki-67 index less than 20 %. The expected outcome has to be compared to the outcome of alternative treatment strategies. An R0 situation should be the aim of hepatic surgery, but also patients with R1 or R2 resection show a good survival benefit.

ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary Site

“…Debulking surgery may be considered in patients with non-functional tumors if the disease is not progressive over a 6-month period and the patients are suffering from symptoms related to tumor burden. Although some retrospective studies indicate that surgery for liver metastasis is associated with improved survival [19,20,21,22], it remains unclear whether debulking surgery is of benefit in asymptomatic patients, since comparative trials to systemic therapy are lacking. Even if surgery is performed with curative intent, there is a high rate of disease recurrence within 3-5 years [4,23].…”

Metastatic pheochromocytoma to liver without elevation of metanephrines and catecholamines

“…Surgical resection is the only curative therapeutic modality. However, rarely feasible, the resection of hepatic metastases improve symptoms and survival, the effect is greater in patients with a Ki–67 <20% and R0 resection [1], [2], [5].…”

“…The location of the tumor is essential in patients with resectable metastasis because surgery offers the only chance of cure and the best survival rate of 80% at 5 years [1], [2], [5]. MRI has a higher sensitivity and specificity in the case of hepatic metastasis.…”

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

“…R0 resection should be the target in the case of removal of hepatic metastases. Cytoreductive procedures are acceptable [167,168] (*evidence level 2). Resective treatment of hepatic metastases of PNETs is considered only in NETs of G1 and G2 [164] (*evidence level 3).…”