Surgical approaches for liver metastases in carcinoid tumors

Neuroendocrine tumors (NETs) are a broad family of tumors which originate from cells of nervous and endocrine systems. Most of these tumors arise from small bowel, large bowel, or the pancreas. More than half of Gastro-entero-pancreatic (GEP) NETs are non-functioning tumors which secret no hormones or biologically inactive hormones, and remain symptomatically silent until a large tumor volume leads to non-specific symptoms such as jaundice, intestinal obstruction, abdominal pain etc. In these tumors morbidity and mortality mainly result from tumor mass or distant metastases. On the other hand, Some NETs are functioning tumors which can distinctively secret several biologically active hormones or peptides. Primary tumor location in the duodenum or pancreas, the excess hormone production, the multitude of hepatic lesions, and ultimate liver disease were noted to be an indicators of poor prognosis (1). These tumors morbidity and mortality are the results of hormonal or hormone-related symptoms, but can also be the consequence of problems caused by tumor expansion. Plasma Chromgranin A (CgA) is a common tumor marker and it should be measured in every patient with a suspected NETs. Sensitivity and specificity of CgA for the detection of NET is 68% and 100%, respectively (2,3)