Mirarchi Mariateresa, De Raffele Emilio, Cuicchi Dajana, Lecce Ferdinando, Cruciani Giorgio, Cola Bruno
Ann Ital Chir. 2015 Jul-Aug;86(4):317-22.
Neuroendocrine tumours (NETs) of the midgut are often multifocal and have a noticeable attitude to metastasize to locoregional lymph nodes and liver. Surgery is the only curative treatment for metastatic NETs of the midgut, even though only a minority of patients are candidates to radical surgical resection. The optimal timing for surgical resection in case of synchronous presentation of primary intestinal neoplasms and resectable LM is still controversial, especially when LM are multiple and/or involve multiple liver segments. Even though a staged approach with initial intestinal resection followed by liver resection is still preferred, recent studies have shown favourable results for simultaneous procedures, which have the striking advantage of avoiding a second laparotomy, with morbidity and mortality rates comparable to staged resections. We report here the case of a patient with double midgut well-differentiated NET and thirty-two synchronous bilobar LM who received successful simultaneous curative right hemicolectomy and radical but conservative liver resection and radiofrequency thermal ablation with the guidance of intraoperative ultrasonography. He is alive without evidence of recurrence 48 months after surgery.
中肠神经内分泌肿瘤（NETs）通常为多灶性，且有向局部区域淋巴结和肝脏转移的明显倾向。手术是中肠转移性NETs的唯一治愈性治疗方法，尽管只有少数患者适合进行根治性手术切除。对于原发性肠道肿瘤与可切除肝转移瘤（LM）同时出现的情况，手术切除的最佳时机仍存在争议，尤其是当LM为多发和/或累及多个肝段时。尽管仍倾向于采用先进行肠道切除再进行肝脏切除的分期方法，但最近的研究表明同期手术效果良好，其显著优势是避免了二次剖腹手术，发病率和死亡率与分期切除相当。我们在此报告一例患有双发性中肠高分化NET和32个同期双叶LM的患者，该患者在术中超声引导下成功接受了同期根治性右半结肠切除术、根治性但保守的肝脏切除术及射频热消融术。术后48个月，他仍存活，无复发迹象。
