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[神经内分泌肿瘤的寡转移灶——手术范围]

[Oligometastases of neuroendocrine tumors-extent of surgery].

作者信息

Bösch F, Werner J, Angele M K, Guba M O

机构信息

Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland.

出版信息

Chirurg. 2018 Jul;89(7):516-522. doi: 10.1007/s00104-018-0644-z.

Abstract

Neuroendocrine tumors (NETs) are rare neoplasms, which represent complex challenges in diagnosis and treatment. Even in the metastatic stage there are important differences in the type of tumor in comparison to gastrointestinal and pancreatic adenocarcinomas. Therefore, the disease courses are substantially different depending on the grade of differentiation. Even in the metastatic stage the 5‑year survival rates of G1 tumors is up to 83%. Approximately 20% of small intestine NETs additionally show hormone activity, which can compromise survival and the quality of life. For individual treatment decisions the special tumor biology of these tumors must be taken into consideration more so than for other tumor entities. Surgery always becomes important for these tumors when a R0 resection appears possible. Oligometastasis of the liver and the lymph drainage system can be meaningfully approached by surgical treatment. In selected patients with an isolated liver involvement, a liver transplantation can be considered; however, even tumor debulking can lead to improvement in the quality of life and survival, especially for hormone active tumors with a carcinoid syndrome which cannot be conservatively controlled. The aim of this review is to present the value of surgical treatment options in the case of (oligo)metastasized NETs.

摘要

神经内分泌肿瘤(NETs)是罕见肿瘤,在诊断和治疗方面面临复杂挑战。即便处于转移阶段,与胃肠道和胰腺腺癌相比,肿瘤类型仍存在重要差异。因此,疾病进程因分化程度不同而有显著差异。即使在转移阶段,G1级肿瘤的5年生存率仍高达83%。约20%的小肠NETs还具有激素活性,这可能影响生存及生活质量。对于个体化治疗决策而言,相较于其他肿瘤类型,这些肿瘤特殊的生物学特性更需予以考虑。当有望实现R0切除时,手术对这些肿瘤始终至关重要。肝寡转移及淋巴引流系统可通过手术治疗有效处理。对于部分仅累及肝脏的患者,可考虑肝移植;然而,即使肿瘤减瘤手术也可改善生活质量和生存状况,尤其是对于伴有类癌综合征且无法通过保守治疗控制的激素活性肿瘤。本综述旨在阐述(寡)转移NETs手术治疗方案的价值。

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