Neuroendocrine Liver Metastases

• Neuroendocrine liver metastases (NELMs) occur in 50-95% of endocrine tumors and represent the main cause of death. Management of NELMs is challenging and should take into account factors such as the tumor biological behavior, the presence of symptoms, and the age and performance status of the patient.

• Different therapeutic options (such as partial hepatectomy, liver transplantation, non-surgical liver directed therapies, and systemic treatments) can be used alone or in combination.

• Surgical resection remains the gold standard and the only potentially curative treatment for NELMs. Despite high recurrence rates, partial hepatectomy is performed with curative intent (in a minority of patients due to the high frequency of multiple and bilateral metastases) or for control of symptoms. Partial hepatectomy is usually indicated in patients with no extrahepatic disease when at least 90% of tumor burden can be resected.

• The role of liver transplantation (LT) for NELMs remains unclear and established selection criteria are lacking. Reasons to support LT are the usual indolent tumor behavior, tendency to metastatize to the liver, reduced possibilities for curative intention partial hepatectomy, and high recurrence rates after partial hepatectomy. Liver transplant should be considered in carefully selected patients with unresectable NELMs confined to the liver.