Management of well-differentiated gastrointestinal neuroendocrine tumors metastatic to the liver

Neuroendocrine tumors (NETs) can have indolent clinical courses and patients with metastatic disease may live many years after the initial diagnosis. Recent studies have suggested that aggressive treatments may extend survival. In this review, we assess the recent literature regarding management of well-differentiated NETs from the gastrointestinal (GI) tract metastatic to the liver. We focus on studies regarding surgical resection, embolization, or ablation of hepatic lesions. We also present a management algorithm for patients who present with metastatic lesions but the primary lesion cannot be located. Since NETs are rare, all of the available evidence is based on retrospective studies that have limited sample size. As a result, recommendations are offered with caution.