Long-term outcome of patients undergoing resection versus transplantation for neuroendocrine liver metastases meeting the Milan Criteria

Liver resection is considered the treatment of choice for resectable neuroendocrine liver metastases (NELM), while liver transplantation is currently reserved for highly selected unresectable patients. We retrospectively analyzed data from consecutive patients undergoing either curative resection or transplantation for liver-only NELM meeting Milan Criteria at a single center between 1984 and 2019. Patients who fit Milan-criteria were 48 in the transplantation group and 56 in the resection group. After a median follow up of 158 months for the transplantation group and 126 for the resection group, the 10-year survival rate was 93% for transplantation and 75% for resection (p = 0.047). The 10-year disease-free survival rate was 52% for transplantation and 18% for resection (p < 0.001). Transplantation was associated with improved survival at univariate analysis. The median disease-free interval between surgery and recurrence was 78 months for transplantation vs. 24 months for resection (p<0.001). The transplantation group had more multisite recurrences (12/25, 48% vs. 5/42, 12% in the resection group, p=0.001), while most recurrences in the resection group were intra-hepatic (37/42, 88%, versus 2/25, 8% in the transplantation group). In conclusion, liver transplantation was associated with improved survival outcomes in NELM meeting the Milan criteria compared with liver resection.