Liver transplantation for neuroendocrine tumors: the patient′s cure or just palliation?

Neuroendocrine tumors (NETs) are a heterogenous group of tumors. Most commonly they occur in the intestine and pancreas, but they are also found in the lung and elsewhere. Synchonous liver metastases are detected in 65-95% of cases independent of the primary tumor, its extent, differentiation and proliferation. Liver metastasis can be approached with an curative intention with both liver resection or transplantation provided that the patient is otherwise free of NET. Both therapies achieve excellent results with a 5-year-survival rate of 60-80% and 97%, respectively; however, selection criteria allow surgical treatment in only between 1-25% of patients. For palliation, both tumor ablation and transarterial chemoembolization are effective for local tumor control. Additional somatostatin-analoga are first-line systemic antiproliferative treatment-options for palliative patients. Up to date prospective randomized trials (RCT) are pending. Thus, todays treatment regimens are based on retrospective data limited due to the high heterogenity of NET. Therefore, patients with NET must be treated in highly specialized centers for best clinical outcome.