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Review
. 2023 Mar 23;12(7):2456.
doi: 10.3390/jcm12072456.

Defining a New Classification System for the Surgical Management of Neuroendocrine Tumor Liver Metastases

Kelly M Mahuron  1 , Gagandeep Singh  1
Affiliations
Review

Defining a New Classification System for the Surgical Management of Neuroendocrine Tumor Liver Metastases

Kelly M Mahuron et al. J Clin Med. .

Abstract

Although rarely curative, hepatic cytoreduction of neuroendocrine tumor liver metastases (NETLM) is associated with improved symptom control and prolonged survival. Preoperative 68Ga DOTATATE and gadoxetic acid-enhanced liver MRI can improve characterization of hepatic disease extent to improve surgical clearance, and resection of the primary tumor is associated with improved survival regardless of whether the liver metastases are treated. As parenchymal-sparing surgical techniques and the lowering of the debulking threshold have expanded the numbers of eligible NETLM patients for hepatic cytoreduction, we propose a new classification system to help guide surgical management. A multimodal approach that includes surgery, liver-directed therapies, and systemic therapies has improved outcomes and increased longevity for patients with well-differentiated metastatic NET.

Keywords: hepatic cytoreduction; hepatic debulking; neuroendocrine liver metastases (NETLM).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative example demonstrating NETLM detection for one patient with different imaging modalities including (A) triple-phase CT scan (arterial and venous phases) (B) standard MRI with gadolinium contrast (arterial and venous phases) (C) 68Ga DOTATATE PET CT imaging (fused phase) and (D) MRI with hepatocyte-specific contrast agent gadoxetic acid (20 min delay phase). * symbol denotes hepatic cyst demonstrating that each representative image corresponds to the same anatomic location.
Figure 2
Figure 2
Proposed classification system of neuroendocrine tumor liver metastases (NETLM) to guide surgical management. The four types are defined by hepatic involvement, ability to achieve the recommended 70% debulking threshold with cytoreduction, and symptoms.
See this image and copyright information in PMC

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Grants and funding

This research received no external funding.