title: Role of liver transplantation in the management of metastatic neuroendocrine tumors.
abstract: BACKGROUND
  In the majority of patients transplanted for unresectable liver metastases, long-term results are disappointing because of early tumor recurrence. Due to its biologically less aggressive nature, neuroendocrine metastases (NM) may represent a good indication for liver transplantation (LT).
  
  
  METHODS
  Between January 1996 and May 2000, five patients with NM were transplanted. The primary tumors were located in the pancreas (n=4) and the small bowel (n=1). In three cases there were symptoms related to hormone production: two carcinoids, and one gastrinoma. The management of primary tumors was sequential in three patients with the tumor being resected before LT (one Whipple procedure and two left pancreatectomies). In two patients the resections of the primary tumors and the LT were simultaneous namely one bowel resection and one left pancreatectomy. All patients were treated with chemotherapy.
  
  
  RESULTS
  Two patients developed recurrent disease succumbing at 15 months (nonfunctioning NE pancreatic head tumor) and 17 months (carcinoid of the pancreatic tail) post-LT. Another patient died at 3 months post-LT due to technical complications. The other two patients are alive and free of recurrence.
  
  
  CONCLUSIONS
  Despite the promising results obtained with LT for NM, our experience indicates that patients must be carefully selected. Perhaps the use of more aggressive chemotherapeutic protocols combined with an individualized approach will improve the results.
authors.affiliation: Servicio de Cirugia 1, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. jumanjico@yahoo.com
authors.forename: J A
authors.initials: JA
authors.lastname: Fernández
authors.forename: R
authors.initials: R
authors.lastname: Robles
authors.forename: C
authors.initials: C
authors.lastname: Marín
authors.forename: Q
authors.initials: Q
authors.lastname: Hernández
authors.forename: F
authors.initials: F
authors.lastname: Sánchez Bueno
authors.forename: P
authors.initials: P
authors.lastname: Ramírez
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: J A
authors.initials: JA
authors.lastname: Luján
authors.forename: J C
authors.initials: JC
authors.lastname: Navalón
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome