title: Hepatic parenchymal preserving technique in the management of diffuse bilateral neuroendocrine tumour liver metastases: a feasible approach.
abstract: BACKGROUND
  Aggressive surgical resection of neuroendocrine tumour liver metastases (NET-LM) is associated with symptomatic relief. Debulking up to 90% of tumour burden, even with positive margins, may be beneficial. However, patients with diffuse hepatic metastases may not qualify for resection owing to associated insufficient remnant liver parenchyma. The purpose of this study is to describe an early experience with a hepatic parenchymal preserving (HPP) approach.
  
  
  METHODS
  We retrospectively reviewed our institutional neuroendocrine tumours database to identify patients with NET-LM, including symptomatic patients with extensive bilobar involvement, who underwent virtual volumetric assessment (VVA) combined with HPP resection between October 2008 and July 2011.
  
  
  RESULTS
  Our study involved 9 patients. The median number of liver metastases resected was 10 (range 4-50). Symptomatic improvement was observed in all patients. Immediate postoperative normalization of 5-HIAA 24-hour urine levels occurred in 89% of patients. Symptomatic and biochemical response remained stable or improved in 75% of patients at 12 months of follow-up. Four patients had postoperative complications. There was no 90-day mortality.
  
  
  CONCLUSIONS
  The described HPP approach is feasible and safe. Most patients experienced symptomatic and biochemical improvement. This reproducible approach could expand surgical resection options for patients with NET-LM and diffuse bilobar involvement.
authors.affiliation: The Division of General Surgery, University of Toronto, Toronto, Ont.
authors.forename: Ashlie
authors.initials: A
authors.lastname: Nadler
authors.affiliation: The Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Moises
authors.initials: M
authors.lastname: Cukier
authors.affiliation: The Division of Medical Imaging, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Laurent
authors.initials: L
authors.lastname: Milot
authors.affiliation: The Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Simron
authors.initials: S
authors.lastname: Singh
authors.affiliation: The Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Law
mesh_terms: D000328:Adult; D000368:Aged; D053379:Chromogranin A / Q000378:metabolism; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000378:metabolism; D008113:Liver Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000378:metabolism / Q000556:secondary* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D053379:Chromogranin A; D006897:Hydroxyindoleacetic Acid