Updates on the management of neuroendocrine liver metastasis

Approximately one-third of patients diagnosed with a neuroendocrine tumor (NET) develop distant metastases, with the liver being the most common site. Therefore, the management of patients with neuroendocrine liver metastasis (NELM) is particularly important, as metastatic disease is often one of the main factors influencing patient prognosis. When patients are amenable to surgery, liver resection is associated with improved long-term outcomes and relief from potential tumor-related symptoms. NELM resection should be considered even when a radical resection is not achievable. Moreover, a tumor burden threshold of 70% for hepatic cytoreductive surgery can be safely adopted with favorable long-term outcomes. For patients with NELM who are not candidates for surgical resection, liver-directed therapies provide a valuable treatment strategy, enabling optimal disease control while preserving liver parenchyma. Furthermore, liver transplantation has emerged as a potential therapy for patients with NELM. Although significant progress has been made in managing NELM, the heterogeneity of NETs poses substantial challenges to research due to the variability in tumor characteristics. Therefore, devising an optimal therapeutic strategy requires a multidisciplinary approach to develop individualized treatment plans and optimize patient outcomes.