title: The role of cytoreductive hepatic surgery as an adjunct to the management of metastatic neuroendocrine carcinomas.
abstract: 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.
authors.affiliation: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612-9497, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Hodul
authors.forename: Mokenge
authors.initials: M
authors.lastname: Malafa
authors.forename: Junsung
authors.initials: J
authors.lastname: Choi
authors.forename: Larry
authors.initials: L
authors.lastname: Kvols
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents