Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2021 Jun;28(6):489-497. doi: 10.1002/jhbp.956. Epub 2021 Apr 20.
BACKGROUND/PURPOSE: Hepatic resection is considered the treatment of choice for neuroendocrine liver metastases (NELM). However, the safety and efficacy of resection have not been fully evaluated using a large cohort. The aim of the present study was to collect real-world data regarding hepatic resections for NELM.
A retrospective, multicenter survey was conducted. The background characteristics of patients undergoing an initial hepatic resection for NELM, the operative details, pathological findings, and patient outcomes were investigated.
A total of 222 patients were enrolled from 30 institutions. The primary tumor site was the pancreas in 58.6%, and the presentation of NELM was synchronous in 63.1% of the cases. Concomitant resection of the primary tumor and liver metastases was performed for 66.4% of the synchronous metastases, and the 90-day morbidity and mortality rates were 12.6% and 0.9%, respectively. The operations resulted in R2 resections in 26.1% of the cases, and 83.4% of the patients experienced recurrence after R0/1 resections. However, the patients were treated using multiple modalities after R2 resection or recurrence, and the overall survival rate was relatively favorable, with 5-year and 10-year survival rates of 70.2%, and 43.4%, respectively. Univariable and multivariable analyses identified the tumor grading (G3) of the primary tumor as a significant prognostic factor for both the recurrence-free and overall survivals.
The present data confirmed the safety of the surgical resection of NELM. Although recurrences were frequent, the survival outcomes after resection were favorable when a multi-disciplinary treatment approach was used.
背景/目的：肝切除术被认为是治疗神经内分泌肝脏转移瘤（NELM）的首选方法。然而，使用大样本队列尚未充分评估切除术的安全性和有效性。本研究旨在收集关于 NELM 肝切除术的真实世界数据。
进行了一项回顾性、多中心调查。调查了首次接受 NELM 肝切除术患者的背景特征、手术细节、病理发现和患者结局。
从 30 家机构共纳入 222 例患者。原发肿瘤部位在胰腺的占 58.6%，NELM 的表现为同步的占 63.1%。同步转移的 66.4%同时切除了原发肿瘤和肝转移灶，90 天发病率和死亡率分别为 12.6%和 0.9%。手术中 R2 切除占 26.1%，R0/1 切除后 83.4%的患者复发。然而，R2 切除或复发后，患者采用了多种治疗方式，总体生存率相对较好，5 年和 10 年生存率分别为 70.2%和 43.4%。单变量和多变量分析均发现原发肿瘤的肿瘤分级（G3）是无复发生存和总体生存的显著预后因素。
本研究数据证实了 NELM 手术切除的安全性。尽管复发较为常见，但采用多学科治疗方法后，切除后的生存结局良好。
