Department of Surgery, Duke University Medical Center, Box 3247, Durham, NC 27710, USA.
Surg Clin North Am. 2010 Aug;90(4):853-61. doi: 10.1016/j.suc.2010.04.016. Epub 2010 Jun 9.
This review summarizes regional strategies for management of neuroendocrine liver metastases (NLM), including hepatic resection, ablation, liver transplantation, and hepatic arterial embolization/chemoembolization. Despite early disease recurrence and/or progression, resection of NLM with or without combined ablation provides long-term survival and symptom improvement. When complete resection of gross liver disease is not feasible, resection as a tumor debulking strategy should be considered in patients with extreme hormonal symptoms refractory to other treatments or with tumors in locations that would affect short-term quality of life. Hepatic arterial embolization with or without local instillation of chemotherapy may induce disease response, symptomatic improvement, and prolonged survival in patients with unresectable NLM. Early disease recurrence, high postoperative mortality, the absence of extensive experience, and lack of universal indications for organ allocation preclude orthotopic liver transplantation as an option for most patients with unresectable NLM.
这篇综述总结了神经内分泌肝脏转移瘤（NLM）的区域管理策略，包括肝切除术、消融术、肝移植术和肝动脉栓塞/化疗栓塞术。尽管早期疾病复发和/或进展，但伴有或不伴有联合消融术的 NLM 切除术可提供长期生存和症状改善。当无法完全切除肝脏疾病时，对于极度激素症状且对其他治疗方法无反应或肿瘤位于影响短期生活质量的部位的患者，应考虑作为肿瘤减瘤策略的切除术。对于不可切除的 NLM 患者，肝动脉栓塞术联合或不联合局部化疗可能会诱导疾病缓解、症状改善和延长生存时间。早期疾病复发、高术后死亡率、缺乏广泛的经验以及器官分配缺乏普遍的适应证，使原位肝移植术不能作为大多数不可切除的 NLM 患者的选择。
