1. Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation
- Author
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Giorgio Ercolani, Nadia Russolillo, Luca Aldrighetti, Guido Torzilli, Alfredo Guglielmi, Agostino Maria De Rose, Francesca Bertuzzo, Andrea Ruzzenente, Francesca Ratti, Alessandro Cucchetti, Simone Conci, Alessandro Ferrero, Pasquale Perri, Gian Luca Grazi, Matteo Cimino, Andrea Dore, Tommaso Campagnaro, Calogero Iacono, Fabio Bagante, Felice Giuliante, Ruzzenente, Andrea, Bagante, Fabio, Bertuzzo, Francesca, Aldrighetti, Luca, Campagnaro, Tommaso, Ercolani, Giorgio, Conci, Simone, Giuliante, Felice, Dore, Andrea, Ferrero, Alessandro, Torzilli, Guido, Grazi, Gian Luca, Ratti, Francesca, Cucchetti, Alessandro, De Rose, Agostino M., Russolillo, Nadia, Cimino, Matteo, Perri, Pasquale, Guglielmi, Alfredo, Iacono, Calogero, Ruzzenente, A, Bagante, F, Bertuzzo, F, Aldrighetti, L, Campagnaro, T, Ercolani, G, Conci, S, Giuliante, F, Dore, A, Ferrero, A, Torzilli, G, Grazi, Gl, Ratti, F, Cucchetti, A, De Rose, Am, Russolillo, N, Cimino, M, Perri, P, Guglielmi, A, and Iacono, C
- Subjects
Male ,medicine.medical_specialty ,Neuroendocrine liver metastasi ,Liver volume ,medicine.medical_treatment ,Milan criteria ,Liver transplantation ,Gastroenterology ,NO ,Resection ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Hepatectomy ,Humans ,Liver surgery ,Neuroendocrine liver metastasis ,Liver transplant ,Liver surgery, Liver transplant, Neuroendocrine liver metastasis, Surgery, Gastroenterology ,LS7_4 ,Aged ,Tumor size ,business.industry ,Patient Selection ,Liver Neoplasms ,TUMOR LIVER ,Middle Aged ,medicine.disease ,Liver Transplantation ,Tumor Burden ,Survival Rate ,Neuroendocrine Tumors ,030220 oncology & carcinogenesis ,Cohort ,Practice Guidelines as Topic ,030211 gastroenterology & hepatology ,Surgery ,Female ,business - Abstract
Background: The role of liver transplant (LT) for neuroendocrine liver metastasis (NELM) has not been completely defined. While international guidelines included LT as a potential treatment for highly selected patients with advanced NELM, recently, LT has been proposed as an alternative curative treatment for NELM for patients meeting restrictive criteria (Milan criteria). Methods: Using a multi-institutional cohort of patients undergoing liver resection for NELM, the long-term outcomes of patients meeting Milan criteria (resected NET drained by the portal system, stable disease/response to therapies for at least 6 months, metastatic diffusion to < 50% of the total liver volume, a confirmed histology of low-grade, and ≤ 60 years) were investigated. Results: Among the 238 patients included in the study, 28 (12%) patients met the Milan criteria for LT with a 5-year OS of 83%. Furthermore, among patients meeting Milan criteria, subsets of patients with favorable clinic-pathological characteristics had 5-year OS rates greater than 90% including G1 patients (5-year OS, 92%), patients undergoing minor liver resection (5-year OS, 94%), patients with low number of NELM (1–2 NELM), and small tumor size (< 3 cm) (for both groups of patients, 5-year OS, 100%). Conclusions: In our series, only 12% of patients met Milan criteria, and the 5-year OS after liver resection for this small selected group of patients was comparable with that reported in the literature for patients undergoing LT for NELM within Milan criteria. While LT might be the optimal treatment for patients with unresectable NELM, surgical resection should be the first option for patients with resectable NELM.
- Published
- 2018