Journal of Gastrointestinal Surgery

, Volume 16, Issue 10, pp 1981–1992 | Cite as

Treatment of Liver Metastases in Patients with Digestive Neuroendocrine Tumors

  • Roberta Elisa Rossi
  • Sara Massironi
  • Matilde Pia Spampatti
  • Dario Conte
  • Clorinda Ciafardini
  • Federica Cavalcoli
  • Maddalena Peracchi
Review Article



Liver metastases are a strong prognostic indicator in patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Therapeutic options for metastatic NETs are expanding and not mutually exclusive.


This paper reviews the literature relating to multidisciplinary approach towards GEP-NET metastases, to highlight advances in knowledge regarding these tumors, and to understand the interdisciplinary management of individual patients.


A PubMed search was performed for English-language publications from 1995 through 2012. Reference lists from studies selected were manually searched to identify further relevant reports. Manuscripts comparing different therapeutic options and advances for GEP-NET-related liver metastases were selected.


There is considerable controversy regarding the optimal management of GEP-NET metastases. Although radical surgery still remains the gold standard, a variety of other therapeutic options are available for metastatic GEP-NETs, including loco-regional chemotherapy/radiotherapy, radioembolization, systemic peptide receptor radionuclide therapy, biotherapy, and chemotherapy. In selected patients, liver transplantation should also be considered. Systemic somatostatin analogues and/or interferon show anti-proliferative effects, representing an appropriate first-line treatment for most patients. In advanced metastatic NETs, recent options include targeted therapies (i.e., everolimus and sunitinib).


It is evident that multidisciplinary care and multimodality treatments remain the cornerstone of management of NET patients. Since NETs often show a more indolent behavior compared to other malignancies, physicians should aim to preserve a satisfactory quality of life for the patient by personalizing the therapeutic approach according to the tumor’s features and prognostic factors.


Gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) Liver metastases Liver-directed therapies Somatostatin analogues 


Conflicts of Interest

None of the authors has any conflicts of interest.

Financial Disclosures


Guarantor of the Article

Roberta Elisa Rossi, MD.

Writing Assistance

American Journal Experts

Financial Support


Potential Competing Interests



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Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Roberta Elisa Rossi
    • 1
    • 2
    • 3
  • Sara Massironi
    • 2
  • Matilde Pia Spampatti
    • 1
    • 2
  • Dario Conte
    • 1
    • 2
  • Clorinda Ciafardini
    • 1
  • Federica Cavalcoli
    • 1
  • Maddalena Peracchi
    • 1
  1. 1.Postgraduate School of GastroenterologyUniversità degli Studi di MilanoMilanItaly
  2. 2.Gastroenterology Unit II, Fondazione IRCCS Ca’ GrandaOspedale Maggiore PoliclinicoMilanItaly
  3. 3.Gastroenterology Unit II, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly

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