World Journal of Surgery

, Volume 38, Issue 3, pp 742–747 | Cite as

Indication for Liver Transplantation in Young Patients with Small Intestinal NETs Is Rare?

  • Olov Norlén
  • Kosmas Daskalakis
  • Kjell Öberg
  • Göran Åkerström
  • Peter Stålberg
  • Per HellmanEmail author



A majority of patients with small intestinal neuroendocrine tumors (SI-NETs) present with or develop liver metastases (LM). A number of treatments for LM are used clinically, including liver transplantation (LTx). Indications for LTx are under debate; young age (<65 years), absence of extrahepatic disease, resected primary tumor and limited extent of LM have been suggested as inclusion criteria for LTx with the aim to optimize outcome.

Materials and methods

From our series of 672 patients with SI-NET treated at the University Hospital in Uppsala between 1985 and 2012, we identified 78 patients according to the following criteria: <65 years of age, locoregional surgery (LRS) of the primary tumor and mesenteric metastases successfully performed, LM present but no extrahepatic disease. Baseline was chosen as the first date the following points were met: First visit to our center, LRS performed, LM present. The patients underwent treatment according to the standard clinical protocols at our center, and during this time period we did not perform or refer any SI-NET patients for LTx. Kaplan–Meier survival analyses were performed in three different groups based on hypothetical criteria for LTx.


Five-year overall survival rates for patients <65 years (n = 78) and <55 years (n = 36) of age were 84 ± 8 and 92 ± 9 %, respectively. For patients fulfilling the Milan criteria (n = 33) the 5-year survival was 97 ± 6 %.


Most young patients (<65 years) with SI-NET and LM have a favorable survival with standardized multimodality treatment. Indeed, most survival figures reported after LTx of NET do not surpass these figures.


Liver Metastasis Liver Resection Multimodality Treatment Extrahepatic Metastasis Extrahepatic Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to Uppsala University, the Swedish Cancer Foundation, and Bergholms Foundation for kind support.


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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Olov Norlén
    • 1
  • Kosmas Daskalakis
    • 1
  • Kjell Öberg
    • 2
  • Göran Åkerström
    • 1
  • Peter Stålberg
    • 1
  • Per Hellman
    • 1
    Email author
  1. 1.Department of Surgical Sciences, University HospitalUppsala UniversityUppsalaSweden
  2. 2.Department of Medical Sciences, University HospitalUppsala UniversityUppsalaSweden

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