Review The surgical management of neuroendocrine tumour hepatic metastases S. Pathak a , I. Dash a , M.R. Taylor a , G.J. Poston b, * a Royal United Hospital Bath NHS Trust, Combe Park, Bath BA1 3NG, United Kingdom b University Hospital Aintree, Liverpool L9 7AL, United Kingdom Accepted 3 December 2012 Available online 3 January 2013 Abstract Although rare in incidence, patients with neuroendocrine tumours (NET) live for many years and so have a high prevalence, and NETs frequently metastasise to the liver (NLM). Numerous treatment options have been implemented both for cure, and to implement disease control. Surgical treatment consists of curative resection, palliative cytoreductive resection and transplantation. Complete surgical resection is possible only in a subset of people with NLMs due to various factors. Ablative therapies may also be used, either as an adjunct to surgery or as a primary treatment. The purpose of the article is to summarise surgical treatment strategies in the management of patients with hepatic neuroendocrine me- tastases. Ó 2012 Elsevier Ltd. All rights reserved. Keywords: Hepatic; Neuroendocrine metastases; Liver; Surgery; Resection Introduction Neuroendocrine tumours (NETs) arise from cells of en- docrine origin, usually within the gut. 1,2 NETs are increas- ing in incidence and prevalence worldwide. 3e5 They cause clinical symptoms by either mass effect (leading to obstruc- tion or compression of other structures) or by secreting ex- cessive amounts of gut hormones. They occur most commonly in the gastrointestinal tract but are also found in other areas, including the bronchi. 1,6e8 NETs often metastasise to the liver. Recent studies have shown 46%e93% of patients with NETs to have liver in- volvement (NLM) at the time of diagnosis. 1 The disease course of these tumours can be far from indolent and liver metastasis represent the greatest threat to life in these patients, 9 and earlier series suggested that the 5-year sur- vival of such patients was only 0%e20%. 1,10 Hepatectomy remains the gold standard of treatment for NLMs but there are no prospective trials comparing surgery with other treatments. There are a number of retrospective reports supporting liver resection with favourable long-term outcomes. 11 Complete surgical resection is only possible in a subset of patients who fit appropriate criteria of limited tumour burden and distribution within the liver. 1,11 Other surgical techniques employed in the management of NLMs include palliative tumour debulking surgery and liver transplantation in certain cases. Other local interven- tions including ablation and hepatic artery delivered thera- pies have also been employed, both as primary treatment and as an adjunct to surgery. Over recent years, non-operative options have developed for patients with NLM who do not fit the surgical criteria, including techniques that have been used in the manage- ment of metastatic colorectal cancer. However, NLM * Corresponding author. E-mail address: graeme.poston@aintree.nhs.uk (G.J. Poston). 0748-7983/$ - see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2012.12.001 Available online at www.sciencedirect.com EJSO 39 (2013) 224e228 www.ejso.com