Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis

Mayo, Skye C.; Jong, Mechteld C. de; Pulitano, Carlo; Clary, B. M.; Reddy, Srinevas K.; Gamblin, T. Clark; Celinksi, Scott A.; Kooby, David A.; Staley, Charles A.; Stokes, Joseph; Chu, Carrie K.; Ferrero, Alessandro; Schulick, Richard D.; Choti, Michael A.; Mentha, G.; Strub, Jennifer; Bauer, Todd W.; Adams, Reid B.; Aldrighetti, Luca; Capussotti, Lorenzo; Pawlik, Timothy M.

doi:10.1245/s10434-010-1154-5

Cited by 423 publications

(378 citation statements)

References 19 publications

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“…Liver metastases accounts for about 90% of the distant metastases of PNET and is a major prognostic factor for this tumor [2,10,11]. Previous researchers have reoprted that the concurrent resection of both the primary lesion and resectable liver metastases is feasible and might improve the prognosis [3][4][5][6]. Palliative cytoreductive surgery refers to the removal of most of the metastasis (>90% of the lesion), during which the concurrent or staged resection of the primary lesion or liver metastases may be considered according to ENETS consensus guidelines [12].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multimodal Therapy for Pancreatic Neuroendocrine Tumors with Multiple Liver Metastases - Two Case Reports

Tokumaru¹,

Shima²,

Okabayashi³

et al. 2017

J Clin Gastroenterol Hepatol

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Complete surgical resection remains the only curative treatment option for pancreatic neuroendocrine tumor (PNET). However, the proper management of PNET with liver metastasis remains debatable. We describe two patients with PNET and multiple liver metastases that were treated with aggressive surgical resection. In one case, a 45-year-old man with non-functional PNET with unresectable liver metastases received cytoreductive operation for both primary PNET and liver metastatic lesions. Thereafter, he received somatostatin analog after transcatheter arterial chemoembolization for residual liver metastases. In the other case, a 70-year-old man with functional PNET, gastrinoma, and resectable liver metastases underwent surgical resection with intent-tocure. Post-operatively, everolimus was administered as an adjuvant treatment. These patients survived after surgical management. These cases suggest that aggressive surgical management with multimodal therapy for PNET with metastases may be effective in achieving long-term survival.

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Section: Discussionmentioning

confidence: 99%

“…PNET remain an important clinical issue due to the high incidence of metastatic rate, and the lack of an evidenced-based treatment strategy [3][4][5][6]. Liver is the most common place for PNET distance metastasis, and literature reports showed a 46% to 93% hepatic metastasis rate [7].…”

Section: Introductionmentioning

confidence: 99%

Multimodal Therapy for Pancreatic Neuroendocrine Tumors with Multiple Liver Metastases - Two Case Reports

Tokumaru¹,

Shima²,

Okabayashi³

et al. 2017

J Clin Gastroenterol Hepatol

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“…Mayo et al [6] reported the outcomes of 339 patients from 8 major hepatobiliary centers who underwent surgical management for neuroendocrine liver metastasis (NELM) from 1985 to 2009. Major hepatectomy was performed in 45% of patients, and 14% underwent a second liver operation.…”

Section: Surgical Resectionmentioning

confidence: 99%

Long-term Survival in Patient with Metastatic Pancreatic Neuroendocrine Tumor Treated by Variable Treatment

Kang¹,

Ryu²,

Lee³

et al. 2017

Korean J Pancreas Biliary Tract

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Well-to-moderately differentiated neuroendocrine tumors of gastroesophageal and pancreatic origin (GEP-NETs) with liver metastasis are a heterogeneous group of malignancies for which a range of therapeutic options have been employed. Surgical resection of hepatic metastases or hepatic artery embolization may be beneficial in patients with hepatic-predominant metastatic disease. Patients with "carcinoid" syndrome and syndromes associated with functional pancreatic NET (PNET) can be effectively treated with somatostatin analogs. On the other hand, the efficacy of systemic chemotherapy for these patients is limited. A placebo-controlled, double-blind, prospective, and randomized study showed that octreotide LAR improves progression-free survival in patients with advanced midgut functional "carcinoids." In patients with advanced pancreatic NET, randomized, placebo-controlled studies have recently demonstrated that treatment with the tyrosine kinase inhibitor sunitinib or with mTOR inhibitor everolimus is associated with improved progression-free survival. Based on these studies, octreotide LAR, sunitinib, or everolimus are now considered as first-line therapeutic options in patients with advanced NET. Future studies will likely further define the role of these agents in patients with carcinoid liver metastasis and pancreatic NET liver metastasis.

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“…Current opinions suggest extended surgical indications for P-NET patients with liver metastases, because survival is improved and P-NET is a slow-growing tumor [1,[6][7][8][9] . For liver metastasis without extrahepatic metastasis, standard/aggressive surgery is the first choice for well-differentiated P-NET categorized as GEP-NET G1/G2 [1,7,8] .…”

Section: Resection Of Liver Metastasesmentioning

confidence: 99%

“…Some cur-MINIREVIEWS rent opinions suggest an expanded surgical indication for P-NET patients with liver metastases, because survival is improved [1,[6][7][8][9] . Aggressive surgery for liver metastases or cytoreductive surgery for over 90% of the visible tumors are important to improve survival [6,9] . Cytoreductive surgery for liver metastases is indicated to reduce hormone levels and improve clinical symptoms and prognosis [1,6,9] .…”

Section: Introductionmentioning

confidence: 99%

Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

Hori¹,

Takaori²,

Üemoto³

2014

WJH

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Pancreatic neuroendocrine tumor (P-NET) is rare and slow-growing. Current classifications predict its prognosis and postoperative recurrence. Curative resection is ideal, although often difficult, because over 80% of patients have unresectable multiple liver metastases and extrahepatic metastasis. Aggressive surgery for liver metastases is important to improve survival. Aggressive or cytoreductive surgery for liver metastases is indicated to reduce hormone levels and improve symptoms and prognosis. Liver transplantation was originally conceived as an ideal therapy for unresectable liver metastases. Unfortunately, there is no clear consensus on the role and timing of surgery for primary tumor and liver metastases. Surgeons still face questions in deciding the best surgical scenario in patients with P-NET with unresectable liver metastases. Key words: Gastroenteropancreatic neuroendocrine tumor; Pancreas; Liver metastasis; Liver surgery; Liver transplantation Core tip: Pancreatic neuroendocrine tumor is rare. Current classifications predict its prognosis and postoperative recurrence. Curative resection is often difficult, because over 80% of patients have unresectable multiple liver metastases and extrahepatic metastasis. Aggressive or cytoreductive surgery for liver metastases is indicated to reduce hormone levels and improve symptoms and prognosis. Liver transplantation was originally conceived as an ideal therapy for unresectable liver metastases. However, there is no clear consensus on the role and timing of surgery for primary tumor and liver metastases.

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Surgical Management of Hepatic Neuroendocrine Tumor Metastasis: Results from an International Multi-Institutional Analysis

Cited by 423 publications

References 19 publications

Multimodal Therapy for Pancreatic Neuroendocrine Tumors with Multiple Liver Metastases - Two Case Reports

Multimodal Therapy for Pancreatic Neuroendocrine Tumors with Multiple Liver Metastases - Two Case Reports

Long-term Survival in Patient with Metastatic Pancreatic Neuroendocrine Tumor Treated by Variable Treatment

Pancreatic neuroendocrine tumor accompanied with multiple liver metastases

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