Liver transplantation and multivisceral transplantation in the management of patients with advanced neuroendocrine tumours

Abstract

Orthotopic liver transplantation (OLT) represents a generally accepted albeit somewhat controversially discussed therapeutic strategy in highly selected patients with non-resectable hepatic metastases from neuroendocrine tumours (NET). Whilst there are some exclusion criteria, these are not universally followed, and the optimal set of inclusion parameters for deeming patients eligible has not yet been elucidated. This is due to heterogeneity in the study populations, as well differing approaches employed and also divergences in selection criteria between centres. Recent data have suggested that OLT may represent the most efficacious approach in terms of overall and disease-free survival to the management of NET metastatic to the liver when conducted in accordance with the modified Milan criteria. Therefore, a consensus set of selection criteria requires definition to facilitate stringent and fair allocation of deceased-donor organs, as well as consideration for living-donor organs. In the context of classically non-resectable metastatic tumour bulk, multivisceral transplantation with or without the liver may also be indicated, yet experience is very limited. In this review, we discuss the diagnostic work-up of patients in whom the aforementioned transplantation approaches are being considered, critically analyse the published experience and also anticipate future developments in this field, including a discussion of immediate and longer-term research priorities.

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

“…Patients with unresectable disease may be considered for orthotopic liver transplantation, and a recent systematic review has detailed median 5-year OS of 63%, comparable to hepatocellular carcinoma [199]. Essentially all published studies have been retrospective in nature, and the selection criteria for transplantation are typically poorly described in many series, if at all [200]. Therefore, it is difficult to identify clear consensus on the optimal selection tools to identify patients most likely to benefit from this radical approach to guide organ allocation.…”

Short- and long-term outcomes of surgery for colorectal and non-colorectal liver metastasis: a report from a single center in the Baltic country

“…Nowadays, the reported 5-year OS rate for CRLM exceeds 50% [7,16] and similar outcomes were achieved in our study. In contrast, the reported OS rate for non-CRLM varies between 5 and 50% [17][18][19][20][21][22], and such differences exist because of high heterogeneity for a different type of tumors in this group of patients. In our cohort, the majority of CRLM originated from the left side colon and rectum, which is typically a more common origin for liver metastasis compared to the right colon [2].…”

Pathogenesis and Clinical Management of Mesenteric Fibrosis in Small Intestinal Neuroendocine Neoplasms: A Systematic Review

“…Importantly, in order to be able to identify patients who might benefit from a prophylactic surgical approach, more insight is needed into the development of MF in SI-NENs [ 94 ]. Of note, multivisceral transplantation including the small intestine is a seldom-utilized approach worldwide for highly selected patients with extensive metastatic burden, i.e., potentially some SI-NEN patients with no liver metastases but extensive metastatic disease in the root of the mesentery and associated MF threatening a vascular catastrophe of the gut by encasement of mesenteric vessels [ 95 ].…”