Highly aggressive policy of hepatic resections for neuroendocrine liver metastases

Background/Aims: Neuroendocrine tumors are usually slow growing and carry a prolonged prognosis. The presence of liver metastases significantly impair s long-term survival. The clinical experience with 28 patients admitted sin ce 1981 for liver metastases from neuroendocrine tumors was retrospectively reviewed to analyze the clinical and surgical management and to evaluate t heir outcome. Methodology: Surgery was indicated in 25 (89.2%) patients. Three had metach ronous metastases. A correct diagnosis of these liver metastases was achiev ed before laparotomy in 15 (68.1%) of the remaining 22. The primary tumor s ite, unknown in 14/22 patients, was located during surgery only in 8 (57.1% ). Results: Due to tumoral spread, surgery was limited to exploration in 3 cas es. Liver resections were performed in 19/22 patients (3 for palliation): 1 1/19 (57.9%) were major hepatectomies and in 8/19 (42.1%) cases they were a ccomplished by procedures for removing the primary tumor. Overall, curative procedures were carried out in 16/28 (51.1%). Resections were performed in 6 cases without the knowledge of the primary site. There was no operative mortality. Overall recurrence rate was 50.0%. Four-year actuarial survival was 92.6% after resection and 18.5% for patients that did not receive surge ry (P<0.001). Conclusions: Our experience confirms that the small number of patients make s the management of liver metastases from neuroendocrine tumors difficult t o plan. In consideration of the satisfactory results achieved with an aggre ssive policy of resection, we advise referral of these patients to speciali zed liver units where major hepatic procedures, even if extended, can be sa fely performed.