Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation

Andrea Ruzzenente, Fabio Bagante, Francesca Bertuzzo, Luca Aldrighetti, Tommaso Campagnaro, Giorgio Ercolani, Simone Conci, Felice Giuliante, Andrea Dore, Alessandro Ferrero, Guido Torzilli, Gian Luca Grazi, Francesca Ratti, Alessandro Cucchetti, Agostino M. De Rose, Nadia Russolillo, Matteo Cimino, Pasquale Perri, Alfredo Guglielmi, Calogero Iacono

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)93-100
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume23
Issue number1
DOIs
Publication statusPublished - Jan 15 2018

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Neuroendocrine Tumors
Liver Transplantation
Neoplasm Metastasis
Liver
Transplants
Portal System

Keywords

  • Liver surgery
  • Liver transplant
  • Neuroendocrine liver metastasis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation. / 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.

In: Journal of Gastrointestinal Surgery, Vol. 23, No. 1, 15.01.2018, p. 93-100.

Research output: Contribution to journalArticle

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 & Iacono, C 2018, 'Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation', Journal of Gastrointestinal Surgery, vol. 23, no. 1, pp. 93-100. https://doi.org/10.1007/s11605-018-3973-9
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. / Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation. In: Journal of Gastrointestinal Surgery. 2018 ; Vol. 23, No. 1. pp. 93-100.
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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.",
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author = "Andrea Ruzzenente and Fabio Bagante and Francesca Bertuzzo and Luca Aldrighetti and Tommaso Campagnaro and Giorgio Ercolani and Simone Conci and Felice Giuliante and Andrea Dore and Alessandro Ferrero and Guido Torzilli and Grazi, {Gian Luca} and Francesca Ratti and Alessandro Cucchetti and {De Rose}, {Agostino M.} and Nadia Russolillo and Matteo Cimino and Pasquale Perri and Alfredo Guglielmi and Calogero Iacono",
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T1 - Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation

AU - Ruzzenente, Andrea

AU - Bagante, Fabio

AU - Bertuzzo, Francesca

AU - Aldrighetti, Luca

AU - Campagnaro, Tommaso

AU - Ercolani, Giorgio

AU - Conci, Simone

AU - Giuliante, Felice

AU - Dore, Andrea

AU - Ferrero, Alessandro

AU - Torzilli, Guido

AU - Grazi, Gian Luca

AU - Ratti, Francesca

AU - Cucchetti, Alessandro

AU - De Rose, Agostino M.

AU - Russolillo, Nadia

AU - Cimino, Matteo

AU - Perri, Pasquale

AU - Guglielmi, Alfredo

AU - Iacono, Calogero

PY - 2018/1/15

Y1 - 2018/1/15

N2 - 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.

AB - 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.

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