Liver transplantation versus liver resection for treatment of neuroendocrine liver metastasis: Appraisal of the current evidence.
Liver resection
Liver transplantation
Neuroendocrine liver metastases
Selection criteria
Tumor biology
Journal
Hepatobiliary & pancreatic diseases international : HBPD INT
ISSN: 1499-3872
Titre abrégé: Hepatobiliary Pancreat Dis Int
Pays: Singapore
ID NLM: 101151457
Informations de publication
Date de publication:
12 Aug 2023
12 Aug 2023
Historique:
received:
01
05
2023
accepted:
10
08
2023
medline:
28
8
2023
pubmed:
28
8
2023
entrez:
27
8
2023
Statut:
aheadofprint
Résumé
Liver transplantation (LT) for neuroendocrine liver metastases (NELM) is still in debate. Studies comparing LT with liver resection (LR) for NELM are scarce, as patient selection is heterogeneous and experience is limited. The goal of this review was to provide a critical analysis of the evidence on LT versus LR in the treatment of NELM. A scoping literature search on LT and LR for NELM was performed with PubMed, including English articles up to March 2023. International guidelines recommend LR for NELM in resectable, well-differentiated tumors in the absence of extrahepatic metastatic disease with superior results of LR compared to systemic or liver-directed therapies. Advanced liver surgery has extended resectability criteria whilst entailing increased perioperative risk and short disease-free survival (DFS). In highly selected patients (based on the Milan criteria) with unresectable NELM, oncologic results of LT are promising. Prognostic factors include tumor biology (G1/G2) and burden, waiting time for LT, patient age and extra-hepatic spread. Based on low-level evidence, LT for low-grade NELM within the Milan criteria resulted in improved DFS and overall survival compared to LR. The benefits of LT were lost in patients beyond the Milan NELM-criteria. With adherence to strict selection criteria especially tumor biology, LT for NELM is becoming a valuable option providing oncologic benefits compared to LR. Recent evidence suggests even stricter selection criteria with regard to tumor biology.
Sections du résumé
BACKGROUND
BACKGROUND
Liver transplantation (LT) for neuroendocrine liver metastases (NELM) is still in debate. Studies comparing LT with liver resection (LR) for NELM are scarce, as patient selection is heterogeneous and experience is limited. The goal of this review was to provide a critical analysis of the evidence on LT versus LR in the treatment of NELM.
DATA SOURCES
METHODS
A scoping literature search on LT and LR for NELM was performed with PubMed, including English articles up to March 2023.
RESULTS
RESULTS
International guidelines recommend LR for NELM in resectable, well-differentiated tumors in the absence of extrahepatic metastatic disease with superior results of LR compared to systemic or liver-directed therapies. Advanced liver surgery has extended resectability criteria whilst entailing increased perioperative risk and short disease-free survival (DFS). In highly selected patients (based on the Milan criteria) with unresectable NELM, oncologic results of LT are promising. Prognostic factors include tumor biology (G1/G2) and burden, waiting time for LT, patient age and extra-hepatic spread. Based on low-level evidence, LT for low-grade NELM within the Milan criteria resulted in improved DFS and overall survival compared to LR. The benefits of LT were lost in patients beyond the Milan NELM-criteria.
CONCLUSIONS
CONCLUSIONS
With adherence to strict selection criteria especially tumor biology, LT for NELM is becoming a valuable option providing oncologic benefits compared to LR. Recent evidence suggests even stricter selection criteria with regard to tumor biology.
Identifiants
pubmed: 37634987
pii: S1499-3872(23)00126-1
doi: 10.1016/j.hbpd.2023.08.007
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.