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



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).


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.


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%).


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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The work of Dr. Francesca Bertuzzo was supported by the Fondo Unico per la Ricerca (FUR) 2017 and the Fondazione Livia and Vittorio Tonolli, Verbania, Italy.

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Authors and Affiliations



- Design of the work: all authors.

- Analysis and interpretation of data for the work: C. Iacono, A. Ruzzenente, and F. Bagante.

- Drafting the work: C. Iacono, A. Ruzzenente, F. Bagante.

- Revising it critically for important intellectual content: all authors.

- Final approval of the version to be published: all authors.

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

Corresponding author

Correspondence to Calogero Iacono.

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Ruzzenente, A., Bagante, F., Bertuzzo, F. et al. Liver Resection for Neuroendocrine Tumor Liver Metastases Within Milan Criteria for Liver Transplantation. J Gastrointest Surg 23, 93–100 (2019).

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  • Neuroendocrine liver metastasis
  • Liver surgery
  • Liver transplant