Neuroendocrine liver metastases

Hepatic metastases represent a fundamental consideration in the effective management of neuroendocrine neoplasms (NEN), given the high propensity of multiple forms of NEN to metastasise to the liver, and their stark effects on survival outcomes. The only curative modality at present is radical resection with microscopically clear margins. However, this is rarely available as most individuals harbour disease which is multifocal and therefore not technically amenable to such an approach. Furthermore, disease recurrence is a major limitation even in 'R0' resection. Alternative surgical strategies may include palliative resection or 'debulking' for patients with medically intractable symptoms or even liver transplantation. More recently, multimodal therapies have been evaluated, with results of combinations of surgical and non-surgical methods to attain disease control in the liver a novel paradigm. Here, we discuss the assessment of neuroendocrine liver metastases as pertains to the surgical armamentarium and clinical results attainable with such approaches.