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International Journal of Hepatology
Volume 2012, Article ID 146590, 13 pages
http://dx.doi.org/10.1155/2012/146590
Review Article

Surgical Treatment of Neuroendocrine Liver Metastases

1Department of Surgical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore 169610
2Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608
3Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857

Received 15 July 2011; Accepted 12 October 2011

Academic Editor: Dermot O'Toole

Copyright © 2012 Ser Yee Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Management of Neuroendocrine liver metastases (NELM) is challenging. The presence of NELM worsens survival outcome and almost 10% of all liver metastases are neuroendocrine in origin. There is no firm consensus on the optimal treatment strategy for NELM. A systematic search of the PubMed database was performed from 1995–2010, to collate the current evidence and formulate a sound management algorithm. There are 22 case series with a total of 793 patients who had undergone surgery for NELM. The overall survival ranges from 46–86% at 5 years, 35–79% at 10 years, and the median survival ranges from 52–123 months. After successful cytoreductive surgery, the mean duration of symptom reduction is between 16–26 months, and the 5-year recurrence/progression rate ranges from 59–76%. Five studies evaluated the efficacy of a combination cytoreductive strategy reporting survival rate of ranging from 83% at 3 years to 50% at 10 years. To date, there is no level 1 evidence comparing surgery versus other liver-directed treatment options for NELM. An aggressive surgical approach, including combination with additional liver-directed procedures is recommended as it leads to long-term survival, significant long-term palliation, and a good quality of life. A multidisciplinary approach should be established as the platform for decision making.