The Evolving Landscape of Neuroendocrine Tumors

NETs are a heterogeneous group of tumors with variable clinical presentations. Surgery remains the mainstay of treatment for most NETs. Multiple society guidelines recommend that a regional lymphadenectomy be performed at the time of PTR as several retrospective studies have shown the increased risk of LN metastases with increasing tumor size and the prognostic significance of LN metastases. The presence of distant metastases at the time of initial diagnosis is common among patients with NETs, which most frequently occur in the liver. Whether by surgical resection, intraoperative or percutaneous ablation, or intra-arterial liver-directed therapies, hepatic cytoreduction of >70% is recommended for patients with NETLM to improve both symptoms and survival. For patients with metastatic, advanced, or unresectable disease, there have been several RCTs that support the use of medical therapies, including SSA, PRRT, and targeted therapies in this patient population. Keeping in mind the available evidence along with its inherent limitations, decisions regarding an individual patient's care should ultimately be made in a multidisciplinary setting with consideration for the patient's risk factors, disease biology, available treatment options, and experience of the treating surgeon to best optimize patient outcomes.