Liver transplantation for neuroendocrine metastases - concepts and challenges : A review of the literature

Abstract

Objective: Gastroenteropancreatic neuroendocrine tumor disease has a low incidence of 5 pr 100 000 and represents many clinical challenges due to little increase in survival the last 30 years. The main goal of this paper is to summarize and discuss opinions and results in selected parts of the material dealing with orthotopic liver transplantation (OLT) for metastatic gastroenteropancreatic neuroendocrine tumor disease. OLT has been suggested in carefully selected patients with long expected survival. The main topics in this paper are patient selection, resection technique, recurrence and quality of life. Methods: Analysis of parts of the material on this subject based on systematic and non-systematic literature search in Pubmed/Medline. Results/conclusion: The analysis shows agreement on some criteria: well differentiated tumor, 6 month interval between primary tumor resection and OLT, absence of any extrahepatic disease are good prognostic factors. Negative prognostic factors are hepatomegaly and numerous hepatic lesions. Resection of primary tumor should be performed with a less extensive operation procedure. More research has to be performed to identify factors for prevention of recurrence. Quality of life measures deserves more standardized and systematic use in clinical trials to provide a more comprehensive knowledge on patient outcome and hence improved clinical decision making. Better tumor classification, identification of tumor markers of different stages of neuroendocrine tumorgenesis for earlier diagnosis together with evidence based selection criteria for OLT and increased attention on quality of life outcomes may increase long term survival in patients with metastatic neuroendocrine tumor disease.