title: Palliative cytoreductive surgery versus other palliative treatments in patients with unresectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours.
abstract: BACKGROUND
  Neuroendocrine tumours are tumours of cells which possess secretory granules and originate from the neuroectoderm. While liver resection is generally advocated in patients with resectable liver alone metastases, the management of patients with liver metastases, which cannot be completely resected, is controversial.
  
  
  OBJECTIVE
  To determine if cytoreductive surgery is better than other palliative treatments in patients with liver metastases from gastro-entero-pancreatic neuroendocrine tumours, which cannot be completely resected.
  
  
  METHODS
  We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until July 2008 for identifying the randomised trials.
  
  
  METHODS
  Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing liver resection (alone or in combination with radiofrequency ablation or cryoablation) versus other palliative treatments (chemotherapy or hormone-therapy or immunotherapy) or no treatment in patients with liver metastases from neuroendocrine tumours, which cannot be completely resected, were considered for the review.
  
  
  METHODS
  Two authors independently identified trials for inclusion.
  
  
  RESULTS
  We were unable to identify any randomised clinical trial suitable for inclusion in this review.
  
  
  CONCLUSIONS
  The literature provides no evidence from randomised clinical trials in order to assess the role of cytoreductive surgery in non-resectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours. High-quality randomised clinical trials may become feasible to perform if their conduct and study design is thoroughly considered in all their practical and methodological aspects. Pilot randomised clinical trials, which can guide the study design of definitive randomised clinical trials, are necessary.
authors.affiliation: University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG. kurinchi2k@hotmail.com
authors.forename: Kurinchi Selvan
authors.initials: KS
authors.lastname: Gurusamy
authors.forename: Viniyendra
authors.initials: V
authors.lastname: Pamecha
authors.forename: Dinesh
authors.initials: D
authors.lastname: Sharma
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D005770:Gastrointestinal Neoplasms; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000601:surgery*; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms; D016032:Randomized Controlled Trials as Topic