Liver Transplantation for Neuroendocrine Metastases
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LIVER TRANSPLANTATION (D MULLIGAN AND R BATRA, SECTION EDITORS)
Liver Transplantation for Neuroendocrine Metastases Giuseppe D’Amico 1 & Teresa Diago Uso 1 Accepted: 23 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Neuroendocrine tumor (NET) metastasis localized to the liver is an accepted indication for liver transplantation as such tumors have a low biological aggressiveness in terms of malignancy and are slow growing. Recent Findings Moreover, the long-term results are comparable with and in some cases even better than those of transplantations performed for primary liver cancer. However, compared with nonmalignant conditions, neuroendocrine liver metastasis (NELM) may result in an inferior outcome of transplantation. In the face of the scarcity of donated organs and recent improved results of non-surgical treatment for NELM, controversy over patient selection and timing for liver transplantation continues. Summary In this review, we provide an overview of the diagnostic workup and selection criteria of patients with NELM being considered for liver transplantation. Thereafter, we provide a critical analysis of the reported outcomes of orthotopic liver transplantation. Keywords Liver transplantation . Neuroendocrine liver metastases . Selection criteria . Outcomes
Introduction Neuroendocrine tumors (NETs) arise from the widespread neuroendocrine system and include carcinoid tumors, pancreatic islet cell tumors (i.e., gastrinoma, insulinoma, glucagonoma, vasoactive intestinal peptide–secreting tumors, and somatostatinoma), paragangliomas, pheochromocytomas, and medullary thyroid carcinomas [1]. These tumors can be placed into two broad categories. The first group includes high-grade malignant neoplasms with a characteristic, small-cell, undifferentiated or anaplastic appearance by light microscopy. These conditions are characterized as poorly differentiated neuroendocrine carcinomas. The second group has variable but most often indolent biologic behavior and characteristic, well-differentiated histologic features; they arise primarily in the gastrointestinal tract but also appear in the lungs, kidneys, and ovaries [1]. Gastrointestinal NETs are usually slow growing and are diagnosed at late stages. When metastases occur, This article is part of Topical Collection on Liver Transplantation * Teresa Diago Uso [email protected] 1
Department of Surgery, Transplantation Center, Cleveland Clinic, Digestive Disease and Surgery Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA
the liver is by far the most commonly involved organ (i.e., 40%–93% of the time), followed by the lung and bone [1, 2]. Therapeutic strategies for neuroendocrine liver metastases (NELM) may incorporate surgical approaches, i.e., resection with curative or palliative intention, peptide receptor radionuclide therapy, liver-directed trans-arterial or percutaneous treatments, and medical therapies [3]. Hepatic surgery is the only approach offering potential cure, and resection of liver deposits if attainable has cl
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