Musholt T J, Lang H
Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz, Langenbeck-Strasse 1, Mainz, Germany.
Chirurg. 2009 Feb;80(2):113-21. doi: 10.1007/s00104-008-1614-7.
Neuroendocrine malignancies encompass a variety of tumors that differ considerably in origin, hormonal activity, and biological behavior. Because of their rarity most therapeutic recommendations have been based on limited evidence from small retrospective series observing miscellaneous patient cohorts. Only in recent years proposals for TNM and histological grading systems have been elaborated that allow further stratification of patients suffering from these tumors. Especially patients with well and moderately differentiated neuroendocrine malignancies benefit from resection of liver metastases, improving the 5-year survival rate from <50% to 80%. Orthotopic liver transplantation can likewise improve survival in carefully selected patients. New developments in imaging modalities, intensive care treatment, and in liver surgery itself have broadened the selection of potentially resectable tumors.
神经内分泌恶性肿瘤包括多种起源、激素活性和生物学行为差异很大的肿瘤。由于其罕见性,大多数治疗建议都基于对不同患者队列的小型回顾性系列研究的有限证据。直到近年来,才制定了TNM和组织学分级系统的建议,这使得这些肿瘤患者能够进一步分层。特别是高分化和中分化神经内分泌恶性肿瘤患者可从肝转移灶切除中获益,5年生存率从<50%提高到80%。原位肝移植同样可以提高精心挑选患者的生存率。成像方式、重症监护治疗以及肝脏手术本身的新进展扩大了潜在可切除肿瘤的选择范围。