Debulking of Extensive Neuroendocrine Liver Metastases

Abstract

Patients with small bowel neuroendocrine tumors (SBNET) and pancreas neuroendocrine tumors (PNET) frequently metastasize to the liver. Progressive disease in the liver is the primary cause of disease-specific death. The choices of effective treatment include liver resection and ablation and interventional radiology procedures, including chemoembolization and intra-arterial injection of radioactive spheres. Optimal treatment involves a combination of these approaches to eliminate or debulk liver disease. The surgical approach to metastatic NET in the liver differs significantly from liver resection for colo-rectal metastases. Metastatic lesions are resected by enucleation, making no attempts to obtain negative margins even for large lesions. Deep lesions near major vascular structures are treated by radiofrequency or microwave ablation. Patients with over 30 distinct NET metastases are still candidates for surgical treatment. Patients benefit from surgical debulking and should undergo operation even if not all disease may be treated. Patients with metastatic SBNET and PNET should be evaluated at tertiary centers with experience in surgical treatment of NET liver metastases.