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Reviews in Endocrine and Metabolic Disorders

, Volume 18, Issue 4, pp 473–483 | Cite as

The place of liver transplantation in the treatment of hepatic metastases from neuroendocrine tumors: Pros and cons

  • Carlo Sposito
  • Michele Droz dit Busset
  • Davide Citterio
  • Marco Bongini
  • Vincenzo Mazzaferro
Article
First Online:

Abstract

Liver metastases occur in nearly half of NET patients (MNETs) and heavily affect prognosis, with 5-yr. OS around 19–38%. Although it is difficult to show outcome differences for available treatments, due to the long course of disease, surgery for MNETs remains the most effective option in terms of survival and symptom control. Since MNETs frequently present as an oligo-metastatic, liver-limited disease, unresectable in 80% of cases, liver transplantation (LT) has emerged as a potential curative treatment. Nevertheless, experience with LT for MNETs is limited and burdened by highly heterogeneous outcomes and significant recurrence rate, mostly explained by the variability of selection criteria. Several prognostic factors have been identified: extended surgery on primary tumor associated to LT, elderly patients, pancreatic primary (pNET), extensive liver involvement, poorly differentiated tumors, high Ki67 levels and short wait time to LT. A proper patients’ selection based on these data (Milan NET criteria) allows a significant survival advantage over non-transplant strategies, with excellent outcomes in recent series (69–97.2% 5-yr. OS) as opposed to patients undergoing non-surgical treatments (34–50.9%). Evidence indicates LT as the best option for selected patients with MNETs. The use of organs for MNETs is therefore justified.

Keywords

Cancer/malignancy/neoplasia Neuroendocrine tumors Metastatic disease Liver disease: malignant Liver transplantation Liver metastases Recipient selection 
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Notes

Compliance with ethical standards

No conflicts of interest are declared by the Authors with respect to the material and methodology presented in the manuscript.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Carlo Sposito
    • 1
  • Michele Droz dit Busset
    • 1
  • Davide Citterio
    • 1
  • Marco Bongini
    • 1
  • Vincenzo Mazzaferro
    • 1
    • 2
  1. 1.Gastrointestinal Surgery and Liver TransplantationFondazione IRCCS Istituto Nazionale Tumori (National Cancer Institute)MilanItaly
  2. 2.University of MilanMilanItaly

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