Hepatic surgery for metastatic gastrointestinal neuroendocrine tumors.

Gastrointestinal neuroendocrine cancers are of significant interest to clinicians and basic scientists. Although accuracy of diagnosis has improved with advances in radioimmune and hormonal assays and in the diagnosis of earlier disease by computed tomography (CT) and magnetic resonance imaging (MRI), many patients still present with hepatic metastases. In contrast to most metastatic gastrointestinal cancers, which have rapid clinical progression with a general decrease in performance status or symptoms related to visceral obstruction and pain, the progression of gastrointestinal neuroendocrine cancers is often slow and associated with clinical endocrinopathies from overproduction of gut hormones. This small subgroup of patients with metastatic neuroendocrine malignancies to the liver has become the focus of intensive multimodality therapy.