Liver transplantation in patients with liver metastases from neuroendocrine tumors: A systematic review

Moris, Demetrios; Tsilimigras, Diamantis I.; Ntanasis‐Stathopoulos, Ioannis; Beal, Eliza W.; Felekouras, Evangelos; Vernadakis, Spiridon; Fung, John J.; Pawlik, Timothy M.

doi:10.1016/j.surg.2017.05.006

Cited by 136 publications

(118 citation statements)

References 74 publications

(121 reference statements)

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“…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].…”

Section: Surgical Management Of Nelmsmentioning

confidence: 99%

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

et al. 2019

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The traditionally promulgated perspectives of neuroendocrine neoplasms (NEN) as rare, indolent tumours are blunt and have been outdated for the last 2 decades. Clear increments in their incidence over the past decades render them increasingly clinically relevant, and at initial diagnosis many present with nodal and/or distant metastases (notably hepatic). The molecular pathogenesis of these tumours is increasingly yet incompletely understood. Those arising from the small bowel (SB) or pancreas typically occur sporadically; the latter may occur within the context of hereditary tumour predisposition syndromes. NENs can also be associated with endocrinopathy of hormonal hypersecretion. Tangible advances in the development of novel biomarkers, functional imaging modalities and therapy are especially applicable to this sub-set of tumours. The management of SB and pancreatic neuroendocrine tumours (NET) may be challenging, and often comprises a multidisciplinary approach wherein surgical, medical, interventional radiological and radiotherapeu-tic modalities are implemented. This review provides a comprehensive overview of the epidemiology, pathophysiology, diagnosis and treatment of SB and pancreatic NETs. Moreover, we provide an outlook of the future in these tumour types which will include the development of precision oncology frameworks for individualised therapy, multi-analyte predictive biomarkers, artificial intelligence-derived clinical decision support tools and elucidation of the role of the microbiome in NEN development and clinical behaviour.According to SEER version 18, SBNEN and PanNEN incidences are currently estimated at 1.2 and 0.7 per 100,000, respectively [5]. The overall 20-year duration prevalence of all NEN is estimated at 171,321; SBNEN constituting 32,122 patients with 3-fold fewer PanNEN (10,707) [5]. Possible attributable factors for this increase evolving epidemiology include increased use of endoscopy and also improvements in the sensitivity of widely used imaging modalities, leading to increased detection of early-stage, asymptomatic disease [5].The median overall survival (OS) for NEN (irrespective of site and grade) is 9.3 years [5]. For SB (median OS: 14 years), this ranges from 70 months (advanced disease with distant metastases) to 170 months (localised disease) and from 30 months (Grade 3) to 160 months (Grade 1). For pancreas (median OS: 3.6 years): 21 months (advanced) to 235 months (localised disease) and from 15 months (Grade 3) to 140 months (Grade 1) [5].Multivariable analyses have identified that ethnicity, age, differentiation, stage and site all have statistically significant correlations with survival. In general, Caucasian ethnicity, age (< 50 years) and localised, well-differentiated NEN exhibit the best survival. SB tumour patients are approximately 1.5 times more likely to survive longer than those with PanNEN [19]. Many of these correlations are self-evident since they pertain to degree of malignancy, disease duration and patient performance status.OS (median 5-year) app...

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Section: Surgical Management Of Nelmsmentioning

confidence: 99%

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

et al. 2019

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“…With over 200 reported cases of pancreatoblastoma in the literature, we found no prior report of a successfully treated metastatic pancreatoblastoma by orthotopic liver transplant . While there is published experience in adults with metastatic neuroendocrine tumors of the pancreas using a similar strategy for staged procedures with liver transplantation for complete excision of disseminated liver metastatic disease, there is not a published experience of liver transplantation for this particular tumor, metastatic pancreatoblastoma . Salman et al have reviewed the very rare reported cases of pancreatoblastoma published in adults and their review does not include any cases of liver transplantation.…”

Section: Discussionmentioning

confidence: 97%

Liver transplant for metastatic pancreatoblastoma: 7‐year event‐free survival after chemotherapy, pancreatectomy, complete hepatectomy, and liver transplant

Ghaffarian

Book

Meyers

2017

Pediatric Transplantation

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Pancreatoblastoma is a rare malignant tumor in children. Surgical resection of the tumor is necessary for cure; however, due to its aggressive nature, it is often unresectable at presentation due to tumor size, local invasion, and/or metastasis. Because it is a rare tumor, there is currently no standard treatment regimen. We report a case of a 4-year-old boy who presented with metastatic pancreatoblastoma with multiple large metastases involving all four sectors of the liver. We began treatment with chemotherapy (cisplatin, 5FU, vincristine, and doxorubicin), which significantly reduced the tumor burden in both the pancreas and liver. We then performed a staged subtotal pancreatectomy, complete hepatectomy, and living donor left lateral segment liver transplant. This was followed by postoperative adjuvant chemotherapy. Our patient is alive and healthy and has now been tumor-free for 7 years with no tumor relapse.

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“…Moris and colleagues undertook a systematic review on the role of liver transplantation for NET–liver metastases . Liver resection with curative intent (R0/1 resection) was associated with long‐term survival benefit, but a higher incidence of recurrent metastatic disease.…”

Section: Liver Transplantationmentioning

confidence: 99%

Surgical strategy for neuroendocrine liver metastases

Fung

Chong

2019

Surgical Practice

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Introduction: There are no established strategies for the surgical management of neuroendocrine liver metastases. Surgical treatment options include liver resection, liver transplantation and debulking hepatectomy. Other liver-directed therapies include local ablation and transarterial embolization. Aim: In the present review, we discuss the outcomes of the different surgical treatment modalities for neuroendocrine liver metastases. Patients and methods: A review of the published literature on the surgical management of neuroendocrine liver metastases was undertaken. Results: Liver resection is the curative treatment of choice for patients with grade 1 or 2 liver metastases without concurrent extra-hepatic disease. Liver transplantation is another potentially curative therapy. Debulking hepatectomy might be indicated for symptomatic neuroendocrine liver disease, whereas liver -directed local ablative and trans-arterial treatments should be considered for patients not suitable for liver resection or transplantation. Conclusions: Hepatectomy and liver transplanatation should be offered to patients with resectable neuroendocrine liver metastases in the absence of extrahepatic metastases. 63Neuroendocrine liver metastases multidisciplinary surgical-oncology team to ensure the selection of the optimal treatment strategy.

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Liver transplantation in patients with liver metastases from neuroendocrine tumors: A systematic review

Cited by 136 publications

References 74 publications

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

Liver transplant for metastatic pancreatoblastoma: 7‐year event‐free survival after chemotherapy, pancreatectomy, complete hepatectomy, and liver transplant

Surgical strategy for neuroendocrine liver metastases

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