The role of cytoreductive hepatic surgery as an adjunct to the management of metastatic neuroendocrine carcinomas.
BACKGROUND
Patients with metastatic neuroendocrine cancers to the liver often present with disabling endocrinopathies and pain associated with bulky disease. Quality of life for these patients is poor and can require long-term therapy with somatostatin analogs for control of their symptoms. Alternative therapies to decrease tumor burden and subsequent hormone release have been investigated. Of these, cytoreductive surgery was found to have the most consistent and profound impact on symptom regression and overall survival.


METHODS
Several cases are reported that illustrate an aggressive multimodality approach in the treatment of metastatic neuroendocrine cancers to the liver. The literature is reviewed and the role of cytoreductive surgery in the management of hepatic neuroendocrine metastases is discussed.


RESULTS
Cytoreductive surgery can be performed safely with minimal morbidity and mortality. Regression of symptoms occurs in the majority of patients and survival is prolonged.


CONCLUSIONS
Surgical intervention as part of an aggressive multimodality treatment plan results in improved outcomes for patients with advanced hepatic metastases of neuroendocrine origin. Future directions may include earlier surgical intervention with adjuvant therapies reserved for aggressive recurrent disease.
Hodul
Pamela
P
Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612-9497, USA.
Malafa
Mokenge
M
Choi
Junsung
J
Kvols
Larry
L
D000328:Adult; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D010190:Pancreatic Neoplasms / Q000473:pathology*; D016896:Treatment Outcome; D047368:Tumor Burden
D000970:Antineoplastic Agents