Liver is the most common site of distant metastasis in patients with advanced gastroenteropancreatic neuroendocrine tumors. Presence of liver disease and grade and location of primary tumor are major determinants of prognosis. The clinical presentation of patients with neuroendocrine liver metastasis (NELM) depends on functional status of the primary tumor as well as severity of the liver disease. Various treatment modalities are available for management of patients with NELM, depending on pattern of metastasis and anatomical origin. Complete surgical resection remains the mainstay of treatment and only hope for cure. Tumor-debulking surgery might be considered in patients with extreme hormonal symptoms refractory to other treatments, with some survival benefits. Orthotopic liver transplantation also has been shown to be an accepted alternative in highly selected patients. Liver-directed treatment strategies such as radiofrequency ablation and hepatic artery-based therapies can be offered to patients who are ineligible for surgical resection. Somatostatin analogs, peptide receptor radiotherapy, cytotoxic chemotherapeutics, and novel molecular-targeted drugs embrace the mainstay of systemic therapy in NELM. In this chapter, we review the clinical presentation, diagnosis, and recent developments in management of patients with NELM.
This review contains 9 figures, 5 tables, and 50 references.
Key Words: ablation, chemotherapy, hepatic artery-based therapy, liver metastasis, liver transplantation, molecular-targeted therapy, neuroendocrine tumor, surgical resection
Hepatic Resection for Non-functional Neuroendocrine Liver Metastasis: Does the Presence of Unresected Primary Tumor or Extrahepatic Metastatic Disease Matter?
