title: Current surgical management of pancreatic endocrine tumor liver metastases.
abstract: BACKGROUND
  The management of metastatic disease in pancreatic endocrine tumors (PETs) demands a multidisciplinary approach and the cooperation of several medical specialties. The role of surgery is critical, even when a radical excision cannot always be achieved.
  
  
  METHODS
  A PubMed search of relevant articles published up to February 2011 was performed to identify current information about PET liver metastases regarding diagnosis and management, with an emphasis on surgery.
  
  
  RESULTS
  The early diagnosis of metastases and their accurate localization, most commonly in the liver, is very important. Surgical options include radical excision, and palliative excision to relieve symptoms in case of failure of medical treatment. The goal of the radical excision is to remove the primary tumor bulk and all liver metastases at the same time, but unfortunately it is not feasible in most cases. Palliative excisions include aggressive tumor debulking surgeries in well-differentiated carcinomas, trying to remove at least 90% of the tumor mass, combined with other additional destructive techniques such as hepatic artery embolization or chemoembolization to treat metastases or chemoembolization to relieve symptoms in cases of rapidly growing tumors. The combination of chemoembolization and systemic chemotherapy results in better response and survival rates. Other local destructive techniques include ethanol injection, cryotherapy and radiofrequency ablation.
  
  
  CONCLUSIONS
  It seems that the current management of PETs can achieve important improvements, even in advanced cases.
authors.affiliation: Second Surgical Propedeutical Department, Hippocration Hospital, Medical School, Aristotle University of Thessaloniki, Konstantinopoulos 49, 54642 Thessaloniki, Greece. pavlidth@med.auth.gr
authors.forename: Theodoros E
authors.initials: TE
authors.lastname: Pavlidis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Psarras
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Symeonidis
authors.forename: Efstathios T
authors.initials: ET
authors.lastname: Pavlidis
authors.forename: Athanasios K
authors.initials: AK
authors.lastname: Sakantamis
mesh_terms: D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D055088:Early Detection of Cancer; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000473:pathology*; D016896:Treatment Outcome