Surgical Treatment of Neuroendocrine Metastases to the Liver

Sarmiento, Juan M.; Heywood, Glenroy; Rubin, Joseph; Ilstrup, Duane M.; Nagorney, David M.; Que, Florencia G.

doi:10.1016/s1072-7515(03)00230-8

Cited by 695 publications

(475 citation statements)

References 14 publications

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“…Postresectional overall 5-year survival rates range from 46% in earlier series (Dousset et al 1996) to 85-94% in more recent reports (Mazzaferro et al 2007, Frilling et al 2009, Scigliano et al 2009). Early recurrence however is to be expected with 5-year disease-free survival of !50% in most series (Sarmiento et al 2003, Mazzaferro et al 2007, Scigliano et al 2009). The limited number of patients suitable for hepatic resection and the high postresectional recurrence rate highlight the need for neoadjuvant and adjuvant strategies, such as in approaches for colorectal LM.…”

Section: R170mentioning

confidence: 92%

“…It ranges from a limited, nonanatomical resection to hepatectomy, in some instances in combination with locally ablative measures (Elias et al 2003, Sarmiento et al 2003. Ideally, these patients should be treated in units with extensive experience in advanced hepatic surgery in order to achieve complete disease elimination particularly when the metastatic spread is primarily assessed as nonresectable .…”

Section: R170mentioning

confidence: 99%

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Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

143

104

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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) represent a heterogenous group of tumors arising from a variety of neuroendocrine cell types. The incidence and prevalence of GEPNENs have markedly increased over the last three decades. Symptoms are often absent in early disease, or vague and nonspecific even in advanced disease. Delayed diagnosis is thus common. Chromogranin A is the most commonly used biomarker but has limitations as does the proliferative marker Ki-67%, which is often used for tumor grading and determination of therapy. The development of a multidimensional prognostic nomogram may be valuable in predicting tumor behavior and guiding therapy but requires validation. Identification of NENs that express somatostatin receptors (SSTR) allows for SSTR scintigraphy and positron emission tomography imaging using novel radiolabeled compounds. Complete surgical resection of limited disease or endoscopic ablation of small lesions localized in stomach or rectum can provide cure; however, the majority of GEP-NENs are metastatic (most frequently the liver and/or mesenteric lymph nodes) at diagnosis. Selected patients with metastatic disease may benefit from advanced surgical techniques including hepatic resection or liver transplantation. Somatostatin analogs are effective for symptomatic treatment and exhibit some degree of antiproliferative activity in small intestinal NENs. There is a place for streptozotocin, temozolomide, and capecitabine in the management of pancreatic NENs, while new agents targeting either mTOR (everolimus) or angiogenic (sunitinib) pathways have shown efficacy in these lesions.

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Section: R170mentioning

confidence: 92%

Section: R170mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

143

104

View full text Add to dashboard Cite

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“…However, the overall survival after hepatic resection has been reported in 46-86% at 5 years and 35-79% at 10 years (49,59,60,61,62,63,64,65,66,67,68,69,70,71,72). This wide heterogeneity reflects the selection bias that is present in the majority of series.…”

Section: Surgery Of Lmmentioning

confidence: 99%

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Partelli

Maurizi

Tamburrino

et al. 2014

European Journal of Endocrinology

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The incidence of neuroendocrine tumors (NETs) has increased in the last decades. Surgical treatment encompasses a panel of approaches ranging from conservative procedures to extended surgical resection. Tumor size and localization usually represent the main drivers in the choice of the most appropriate surgical resection. In the presence of small (!2 cm) and asymptomatic nonfunctioning NETs, a conservative treatment is usually recommended. For localized NETs measuring above 2 cm, surgical resection represents the cornerstone in the management of these tumors. As they are relatively biologically indolent, an extended resection is often justified also in the presence of advanced NETs. Surgical options for NET liver metastases range from limited resection up to liver transplantation. Surgical choices for metastatic NETs need to consider the extent of disease, the grade of tumor, and the presence of extra-abdominal disease. Any surgical procedures should always be balanced with the benefit of survival or relieving symptoms and patients' comorbidities.

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“…The advantages of an appropriate debulking are multifold, spanning from resolution of symptoms (in patients that where symptomatic pre-operatively) to associated 5-and 10-year survival rate up to 61 and 35 %, respectively [61].…”

Section: Advanced Diseasementioning

confidence: 99%

Pancreatic Neuroendocrine Tumors: an Update

2015

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Pancreatic neuroendocrine tumors (pNETs) are rare and comprise only 1-2 % of all pancreatic neoplastic disease. Although the majority of these tumors are sporadic (90 %), pNETs can arise in the setting of several different hereditary genetic syndromes, most commonly multiple endocrine neoplasia type 1 (MEN1). The presentation of pNETs varies widely, with over 60 % having malignant distant disease at the time of initial diagnosis involving the liver or other distant sites. Functioning pNETs represent approximately 10 % of all pNETs, secrete a variety of peptide hormones, and are responsible for several clinical syndromes caused by profound hormonal derangement. Surgery remains the cornerstone of therapy and the only curative approach. It should be pursued for localized disease and for metastatic lesions amenable to resection. Multimodality therapies, including liver-directed therapies and medical therapy, are gaining increasing favor in the treatment of advanced pNETs. Their utility is multifold and spans from ameliorating symptoms of hormonal excess (functional pNETs) to controlling the local and systemic disease burden (non-functional pNETs). The recent introduction of target molecular therapy has promising results especially for the treatment of progressive well-differentiated G1/G2 tumor. In this review, we summarize the current knowledge and give an update on recent advancements made in the therapeutic strategies for pNETs.

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Surgical Treatment of Neuroendocrine Metastases to the Liver

Cited by 695 publications

References 14 publications

Neuroendocrine tumor disease: an evolving landscape

Neuroendocrine tumor disease: an evolving landscape

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Pancreatic Neuroendocrine Tumors: an Update

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