Surgical management for non-functional pancreatic neuroendocrine neoplasms with synchronous liver metastasis: A consensus from the Chinese Study Group for Neuroendocrine Tumors (CSNET).
Pancreatic neuroendocrine neoplasms (p-NENs) are slowly growing tumors with frequent liver metastasis. There is a variety of approaches to treat non-functional p-NENs with synchronous liver metastasis (LM) which complicates the determination of optimal treatment. Based on updated literature review, we discussed the treatment strategy determinants for p-NEN with LM. According to the resectability of primary tumor, the WHO 2010 grade classification and the radiological type of liver metastasis, the CSNET group reached agreements on a number of issues, including the following. Prior to treatment, biopsy is required to confirm pathology. Liver biopsy is important for more accurate grading of tumor and percutaneous core needle biopsy is more available than EUS-FNA. In patients with unresectable primary, surgical resection for liver-metastatic lesions should be avoided. Curative surgery is recommended for G1/G2 p-NET with type I LM and R1 resection also seems to improve overall survival rate. Cytoreductive surgery is recommended for G1/G2 p-NET with type II LM in select patients, and should meet stated requirements. Surgical resection for G1/G2 p-NET with type III LM and p-NEC with LM should be avoided, and insufficient evidence exists to guide the surgical treatment of G3 p-NET with LM. Liver transplantation may be an option in highly select patients. In addition, the optimal time for surgical approach is still required for more evidence.
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
Kaizhou
K
Jin
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
Jin
J
Xu
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
Jie
J
Chen
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
Minhu
M
Chen
Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
Rufu
R
Chen
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China.
Ye
Y
Chen
Department of Medical Oncology, Shanghai Cancer Center, Fudan University, Shanghai, P.R. China.
Zhiyu
Z
Chen
Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
Bin
B
Cheng
Department of Medical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China.
Yihebali
Y
Chi
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
Shi-Ting
ST
Feng
Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, P.R. China.
Deliang
D
Fu
Department of General Surgery, Guangdong General Hospital, Guangzhou, Guangdong, P.R. China.
Baohua
B
Hou
Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai, P.R. China.
Dan
D
Huang
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
Heguang
H
Huang
Department of General Surgery, Anhui Provincial Hospital, Hefei, Anhui, P.R. China.
Qiang
Q
Huang
Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Beijing Cancer Hospital, Beijing, P.R. China.
Jie
J
Li
Department of Radiology, Peking University Cancer Hospital, Beijing, P.R. China.
Ying
Y
Li
Department of Oncology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China.
Houjie
H
Liang
Department of Gastroenterology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China.
Rong
R
Lin
Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China.
An'an
A
Liu
Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, P.R. China.
Jixi
J
Liu
Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
Xubao
X
Liu
Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Beijing Cancer Hospital, Beijing, P.R. China.
Ming
M
Lu
Department of Pathology, China-Japan Friendship Hospital, Beijing, P.R. China.
Jie
J
Luo
Department of Hepatobiliopancreatic Surgery, The People's Hospital of Deyang, Chengdu, Sichuan, P.R. China.
Gang
G
Mai
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Pancreatic Cancer Institute, Fudan University, Shanghai, P.R. China.
Quanxing
Q
Ni
Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
Meng
M
Qiu
Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P.R. China.
Chenghao
C
Shao
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
Baiyong
B
Shen
Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai, P.R. China.
Weiqi
W
Sheng
Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.
Jian
J
Sun
Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
Chunlu
C
Tan
Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, P.R. China.
Huangying
H
Tan
Department of Gastroenterology, Jiangsu People's Hospital, Nanjing, Jiangsu, P.R. China.
Qiyun
Q
Tang
Department of Gastroenterology, The Second Affliated Hospital of Kunming Medical University, Yunnan Research Center for Liver Diseases, Kunming, Yunnan, P.R. China.
Yingmei
Y
Tang
Department of General Surgery, Peking University First Hospital, Beijing, P.R. China.
Xiaodong
X
Tian
Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, P.R. China.
Danian
D
Tong
Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, P.R. China.
Xiaohong
X
Wang
Department of Biliary-Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
Jian
J
Wang
Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.
Jie
J
Wang
Department of Surgery, Huadong Hospital, Fudan University, Shanghai, P.R. China.
Wei
W
Wang
Department of Gastric and Pancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P.R. China.
Wei
W
Wang
Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, P.R. China.
Yu
Y
Wang
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
Zheng
Z
Wu
Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.
Ling
L
Xue
Department of Hepatobiliopancreatic Surgery, Huzhou Central Hospital, Huzhou, Zhejiang, P.R. China.
Qiang
Q
Yan
Hepatobiliary Surgery Department V, Eastern Hepatobiliary Surgery Hospital, Shanghai, P.R. China.
Ning
N
Yang
Department of General Surgery, Peking University First Hospital, Beijing, P.R. China.
Yinmo
Y
Yang
Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, P.R. China.
Zhiying
Z
Yang
Department of Biliary-Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.
Xiaoyi
X
Yin
Department of General Surgery, Peking University Third Hospital, Beijing, P.R. China.
Chunhui
C
Yuan
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
Shan
S
Zeng
Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, P.R. China.
Renchao
R
Zhang
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center; Pancreatic Cancer Institute, Fudan University; Shanghai, P.R. China.
Xianjun
X
Yu
D002681:China; D032921:Consensus; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic / Q000592:standards*; D015996:Survival Rate; D016896:Treatment Outcome