[Controversies and prospects for surgical treatment of pancreatic neuroendocrine neoplasms with liver metastases].

The incidence of pancreatic neuroendocrine neoplasm(pNEN) increased over the past two decades. Liver metastasis, the most common type of distal metastasis, is also one of the most important prognostic factors. Although several medical treatments, including biotherapy, chemotherapy, targeted therapy, peptide receptor radionuclide therapy and locoregional therapy, are available for pNEN with liver metastases, surgery is still the only possible treatment for cure. Currently, there are several controversies as regards surgical treatment for pNEN with liver metastases. These controversies include, but are not limited to, whether surgical resection is appropriate for pancreatic neuroendocrine tumor G3 with liver metastases, how to classify primary lesion and hepatic metastases comprehensively and accurately, what is the optimal surgical strategy for type Ⅱ liver metastases, who can benefit greatly from cytoreduction, and how to refine the Milan criteria for liver transplantation. This article aims to discuss those main controversies and provide prospects for future clinical trials.在过去的20年间，胰腺神经内分泌肿瘤（pNEN）的发病率不断升高。肝脏是其最常见的转移部位，肝转移是pNEN患者重要的预后因素。虽然对于pNEN肝转移有包括生物治疗、化疗、靶向治疗、肽受体放射性核素治疗、局部治疗在内的多种治疗方式，但手术仍是唯一可能达到治愈目的的治疗方式。目前对于pNEN肝转移的外科治疗仍存在较多争议，如胰腺神经内分泌瘤（pNET）G3合并肝转移患者能否接受手术治疗；术前如何更加全面且准确地对pNET肝转移患者进行分级诊疗、Ⅱ型pNET肝转移患者如何选择最佳的外科治疗策略、如何确定减瘤手术的最佳获益人群、如何进一步优化pNET肝移植的米兰标准等。本文对目前pNEN治疗的主要争议展开讨论，并为后续的临床研究提出展望。.