Krausch Markus, Raffel Andreas, Anlauf Martin, Schott Matthias, Lehwald Nadja, Krieg Andreas, Topp Stefan Andreas, Cupisti Kenko, Knoefel Wolfram Trudo
Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany,
World J Surg. 2014 Feb;38(2):392-401. doi: 10.1007/s00268-013-2267-3.
Liver metastases of GEP-NETs are a known major prognostic factor with a strong effect on patients' survival. To date, various treatment options are available, whereas surgery remains the only curative option. Because large liver resections often cannot be performed due to insufficient remnant liver volume, a special operative technique, "cherry picking" (multiple nonanatomic liver resections), can be used as a tissue-preserving procedure.
Of 91 patients with various GEP-NETs, 16 patients were identified with synchronous or metachronous multifocal, bilobular liver metastases (>10). All were treated with "cherry picking." Patient records were reviewed retrospectively and clinical data and pathology results were analyzed.
Mean survival after primary tumour resection was 82.8 versus 41.2 months after liver surgery. All 16 patients are still alive. Mean recurrence-free survival after primary tumour operation was 49.8 versus 24.6 months after liver surgery. Complications of cherry picking included two postoperative biliary leakages and three small hepatic abscesses (conservative/interventional approach 25 % (n = 4), surgical approach 6.25 % (n = 1). There was no postoperative mortality. Initial hormonal symptoms (5/16 patients) completely disappeared postoperatively in 2 patients and were significantly decreased in 3 patients.
The tissue-preserving surgical technique "cherry picking" has developed due to improved imaging techniques and increased knowledge in liver anatomy, which has helped to make this approach safer and easier. Highly selected patients with multiple bilobular liver metastases of GEP-NET can benefit from this special surgical approach, also applicable for recurrent metastases.
胃肠胰神经内分泌肿瘤（GEP-NETs）的肝转移是一个已知的主要预后因素，对患者的生存有很大影响。迄今为止，有多种治疗选择，而手术仍然是唯一的治愈性选择。由于残余肝体积不足，往往无法进行大范围肝切除，一种特殊的手术技术“摘樱桃术”（多次非解剖性肝切除）可作为一种保留组织的手术方法。
在91例患有各种GEP-NETs的患者中，有16例被确定为同时性或异时性多灶性、双叶肝转移（>10个）。所有患者均接受“摘樱桃术”治疗。对患者记录进行回顾性审查，并分析临床数据和病理结果。
原发肿瘤切除后的平均生存期为82.8个月，而肝手术后为41.2个月。所有16例患者均存活。原发肿瘤手术后的平均无复发生存期为49.8个月，而肝手术后为24.6个月。“摘樱桃术”的并发症包括2例术后胆漏和3例小肝脓肿（保守/介入治疗占25%（n = 4），手术治疗占6.25%（n = 1））。无术后死亡病例。初始激素症状（5/16例患者）在术后2例患者中完全消失，3例患者中显著减轻。
由于成像技术的改进和肝脏解剖学知识的增加，保留组织的手术技术“摘樱桃术”得到了发展，这有助于使该方法更安全、更容易。高度选择的GEP-NET双叶肝多发转移患者可从这种特殊的手术方法中获益，该方法也适用于复发性转移。
