Berber Eren, Flesher Nora, Siperstein Allan E
Department of General Surgery/A80, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Ohio 44195, USA.
World J Surg. 2002 Aug;26(8):985-90. doi: 10.1007/s00268-002-6629-5. Epub 2002 May 21.
We previously reported on the safety and efficacy of laparoscopic radiofrequency thermal ablation (RFA) for treating hepatic neuroendocrine metastases. The aim of this study is to report our 5-year RFA experience in the treatment of these challenging group of patients. Of the 222 patients with 803 liver primary and secondary tumors undergoing laparoscopic RFA between January 1996 and August 2001, a total of 34 patients with 234 tumors had neuroendocrine liver metastases. There were 25 men and 9 women with a mean +/- SEM age of 52 +/- 2 years who underwent 42 ablations. Primary tumor types included carcinoid tumor in 18 patients, medullary thyroid cancer in 7, secreting islet cell tumor in 5, and nonsecreting islet cell tumor in 4. There was no mortality, and the morbidity was 5%. The mean hospital stay was 1.1 days. Symptoms were ameliorated in 95%, with significant or complete symptom control in 80% of the patients for a mean of 10+ months (range 6-24 months). All patients were followed for a mean +/- SEM of 1.6 +/- 0.2 years (range 1.0-5.4 years). During this period new liver lesions developed in 28% of patients, new extrahepatic disease in 25%, and local liver recurrence in 13%; existing liver lesions progressed in 13%. Overall 41% of patients showed no progression of their cancer. Nine patients (27%) died. Mean +/- SEM survivals after diagnosis of primary disease, detection of liver metastases, and performance of RFA were 5.5 +/- 0.8 years, 3.0 +/- 0.3 years, and 1.6 +/- 0.2 years, respectively. Sixty-five percent of the patients demonstrated a partial or significant decrease in their tumor markers during follow-up. In conclusion, RFA provides excellent local tumor control with overnight hospitalization and low morbidity in the treatment of liver metastases from neuroendocrine tumors. It is a useful modality in the management of these challenging group of patients.
我们之前报道了腹腔镜射频热消融（RFA）治疗肝神经内分泌转移瘤的安全性和有效性。本研究的目的是报告我们在治疗这类具有挑战性的患者群体方面5年的RFA经验。在1996年1月至2001年8月期间接受腹腔镜RFA治疗的222例患有803个肝脏原发和继发肿瘤的患者中，共有34例患者的234个肿瘤为神经内分泌肝转移瘤。其中男性25例，女性9例，平均年龄±标准误为52±2岁，共接受了42次消融治疗。原发肿瘤类型包括类癌瘤18例、甲状腺髓样癌7例、分泌性胰岛细胞瘤5例、非分泌性胰岛细胞瘤4例。无死亡病例，发病率为5%。平均住院时间为1.1天。95%的患者症状得到改善，80%的患者症状得到显著或完全控制，平均持续10多个月（范围6 - 24个月）。所有患者平均随访±标准误为1.6±0.2年（范围1.0 - 5.4年）。在此期间，28%的患者出现新的肝脏病变，25%的患者出现新的肝外疾病，13%的患者出现肝脏局部复发；现有肝脏病变进展的患者占13%。总体而言，41%的患者癌症无进展。9例患者（27%）死亡。原发性疾病诊断后、肝转移瘤检测后以及RFA治疗后的平均±标准误生存期分别为5.5±0.8年、3.0±0.3年和1.6±0.2年。65%的患者在随访期间肿瘤标志物出现部分或显著下降。总之，RFA在治疗神经内分泌肿瘤肝转移方面提供了出色的局部肿瘤控制，住院时间短且发病率低。它是管理这类具有挑战性的患者群体的一种有用方式。
