Machairas Nikolaos, Daskalakis Kosmas, Felekouras Evangelos, Alexandraki Krystallenia I, Kaltsas Gregory, Sotiropoulos Georgios C
2nd Department of Propaedeutic Surgery (Nikolaos Machairas, Georgios C. Sotiropoulos).
1st Department of Propaedeutic Internal Medicine (Kosmas Daskalakis, Krystallenia I. Alexandraki, Gregory Kaltsas).
Ann Gastroenterol. 2021;34(2):130-141. doi: 10.20524/aog.2021.0574. Epub 2021 Jan 16.
Neuroendocrine neoplasms (NEN) are frequently characterized by a high propensity for metastasis to the liver, which appears to be a dominant site of distant-stage disease, affecting quality of life and overall survival. Liver surgery with the intention to cure is the treatment of choice for resectable neuroendocrine liver metastases (NELM), aiming to potentially prolong survival and ameliorate hormonal symptoms refractory to medical control. Surgical resection is indicated for patients with NELM from well-differentiated NEN, while its feasibility and complexity are largely dictated by the degree of liver involvement. As a result of advances in surgical techniques over the past decades, complex 1- and 2-stage, or repeat liver resections are performed safely and effectively by experienced surgeons. Furthermore, liver transplantation for the treatment of NELM should be anchored in a multimodal and multidisciplinary therapeutic strategy and restricted only to highly selected individual cases. A broad spectrum of interventional radiology treatments for NELM have recently been available, with expanding indications that are more applicable, as they are less limited by patient- and tumor-related parameters, being therefore important adjuncts or alternatives to surgery. Overall, liver-targeted treatment modalities may precede the administration of systemic molecular targeted agents and chemotherapy for patients with liver-dominant metastatic disease; these appear to be a crucial component of multimodal management of patients with NEN. In the present review, we discuss surgical and non-surgical liver-targeted treatment approaches for NELM, each complementing the other, with a view to assisting physicians in optimizing multimodal NEN patient care.
神经内分泌肿瘤（NEN）的一个常见特征是极易转移至肝脏，肝脏似乎是远处转移阶段疾病的主要部位，这会影响患者的生活质量和总生存期。旨在治愈的肝脏手术是可切除性神经内分泌肝转移瘤（NELM）的首选治疗方法，目的是潜在地延长生存期并改善药物治疗难以控制的激素症状。对于高分化NEN所致的NELM患者，建议进行手术切除，而其可行性和复杂性在很大程度上取决于肝脏受累程度。由于过去几十年手术技术的进步，经验丰富的外科医生能够安全有效地实施复杂的一期和二期手术或重复肝脏切除术。此外，NELM的肝移植治疗应基于多模式和多学科治疗策略，并且仅适用于经过严格筛选的个别病例。最近，针对NELM出现了广泛的介入放射学治疗方法，其适用范围不断扩大，因为它们受患者和肿瘤相关参数的限制较小，因此是手术的重要辅助手段或替代方法。总体而言，对于以肝脏转移为主的疾病患者，肝脏靶向治疗方式可能先于全身分子靶向药物和化疗的应用；这些似乎是NEN患者多模式管理的关键组成部分。在本综述中，我们讨论了NELM的手术和非手术肝脏靶向治疗方法，二者相辅相成，旨在帮助医生优化NEN患者的多模式治疗。
