The article by Musunuru et al is a retrospective series from a well-respected institution with extensive experience in the treatment of endocrine tumors. Musunuru et al1 examine their experience with 48 patients, seen from 1996 through 2004, with metastatic neuroendocrine tumors confined to the liver. Patients were treated by medical (or no) therapy, hepatic artery embolization, chemoembolization, or surgical resection. In all, 36 patients had carcinoid tumors and 12 had islet cell cancers. The authors examined their experience in light of the lack of existing level I data in the published literature and contribute their findings to reports from other institutions including the Mayo Clinic,1,2 University of California, san Francisco,3 and M. D. Anderson Cancer Center.4 Although this article is a valuable addition to the literature, this study has 2 major limitations. There was a lack of prospective treatment guidelines that could result in a lack of uniformity in the treatment of patients by the various surgeons at this single institution. I am also disappointed that there was no prospective surveillance protocol to monitor the timing and pattern of recurrence.
Demeure MJ. Metastatic Neuroendocrine Hepatic Tumors—Invited Critique. Arch Surg. 2006;141(10):1005. doi:10.1001/archsurg.141.10.1005