Frilling A, Rogiers X, Malagó M, Liedke O M, Kaun M, Broelsch C E
Department of Surgery, University Hospital Hamburg, Germany.
Langenbecks Arch Surg. 1998 Mar;383(1):62-70. doi: 10.1007/s004230050093.
Hepatic metastases of neuroendocrine tumors demand differentiated therapeutic management due to the unique natural course and hormone secretion of the tumors.
The purpose of the prospective nonrandomized study was to review the institutional experience with surgical treatment of hepatic neuroendocrine metastases.
From September 1992 until March 1996 29 consecutive patients with neuroendocrine tumors have been evaluated for surgical treatment of liver metastases. Of them, 11 (37.9%) fulfilled criteria for surgical treatment of hepatic secondary tumors. Extensive preoperative workup was carried out. Patients were divided in groups for curative or palliative resection. Liver transplantation was carried out in selected patients with disseminated liver metastases.
Of 29 patients 4 (13.7%) underwent curative resection and in 3 patients (10.3%) palliative resection was performed. The patients who underwent curative resection are all biochemically and clinically tumor free at a mean postoperative follow-up of 22.3 months. Two patients who underwent palliative resection are alive at 40 and 29 months, respectively. From 12 patients evaluated for liver transplantation 4 were considered as suitable candidates.
Liver resection can be recommended in patients with hepatic metastases of neuroendocrine tumors in terms of potential survival prolongation and palliation. Liver transplantation is generally acceptable treatment in highly selected group of these patients. Long-term results have to be awaited before definitive proof of the beneficial effect of surgical treatment.
神经内分泌肿瘤的肝转移因其独特的自然病程和肿瘤激素分泌需要差异化的治疗管理。
这项前瞻性非随机研究的目的是回顾肝神经内分泌转移瘤手术治疗的机构经验。
从1992年9月至1996年3月，对29例连续的神经内分泌肿瘤患者进行了肝转移瘤手术治疗评估。其中，11例（37.9%）符合肝继发性肿瘤手术治疗标准。进行了广泛的术前检查。患者分为根治性或姑息性切除组。对部分有弥漫性肝转移的患者进行了肝移植。
29例患者中，4例（13.7%）接受了根治性切除，3例（10.3%）进行了姑息性切除。接受根治性切除的患者在术后平均22.3个月的随访中，生化和临床检查均无肿瘤。2例接受姑息性切除的患者分别存活了40个月和29个月。在评估肝移植的12例患者中，4例被认为是合适的候选者。
就潜在的生存延长和姑息治疗而言，肝切除可推荐用于神经内分泌肿瘤肝转移患者。肝移植通常是这些患者中经过高度筛选的组别的可接受治疗方法。在明确证明手术治疗的有益效果之前，还需等待长期结果。
