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肝移植治疗神经内分泌肿瘤:我们有何收获?

Liver Transplantation for Neuroendocrine Tumors: What Have We Learned?

机构信息

Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France.

INSERM, U955, Créteil, France.

出版信息

Semin Liver Dis. 2018 Nov;38(4):351-356. doi: 10.1055/s-0038-1669936. Epub 2018 Oct 24.

Abstract

Neuroendocrine tumors are slow-growing tumors and associated with prolonged overall survival even in the presence of untreated liver metastases. The presence of liver metastases may be responsible for severe symptoms with impairment of quality of life. Liver resection has been proposed to achieve better symptom control and/or improve overall survival, but this concerns less than 20% of patients with liver metastases. In addition, the chance to be really cured after liver resection is around 40%, which prompts consideration of liver transplantation as the only potential curative treatment. Time has come to move beyond the traditional debate around the best candidates and prognostic factors for liver transplantation. This review gives the opportunity to discuss new insights: (1) outcome of liver transplantation for neuroendocrine liver metastases as compared with hepatocellular carcinoma, (2) outcome of salvage liver transplantation as a secondary procedure after surgical resection of neuroendocrine liver metastases, (3) outcome of palliative liver transplantation for neuroendocrine liver metastases, and (4) the chance to be cured after liver transplantation for neuroendocrine liver metastases.

摘要

神经内分泌肿瘤生长缓慢,即使存在未经治疗的肝转移,其总体生存率也较长。肝转移的存在可能导致严重的症状,影响生活质量。肝切除术已被提议用于更好地控制症状和/或改善总体生存率,但这仅适用于不到 20%的肝转移患者。此外,肝切除术后真正治愈的机会约为 40%,这促使人们考虑将肝移植作为唯一潜在的治愈性治疗方法。现在是时候超越传统的关于肝移植最佳候选者和预后因素的争论了。这篇综述提供了一个讨论新见解的机会:(1)肝移植治疗神经内分泌肝转移与肝细胞癌的结果比较,(2)神经内分泌肝转移肝切除术后挽救性肝移植作为二次手术的结果,(3)神经内分泌肝转移的姑息性肝移植结果,以及(4)神经内分泌肝转移肝移植后治愈的机会。

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