Isolated liver metastases from neuroendocrine tumors: Does resection prolong survival?
Isolated liver metastases from neuroendocrine tumors: Does resection prolong survival?
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DOI：
10.1016/s1072-7515(98)00099-4
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发表时间：
1998-07-01
影响因子：
5.2
通讯作者：
Choti, MA
中科院分区：
文献类型：
--
作者：
Chen, H;Hardacre, JM;Choti, MA
背景：神经内分泌肿瘤通常转移到肝脏。虽然手术切除被认为是局限于肝脏的局部转移患者的治疗选择，但肝切除的长期生存益处尚未得到明确证明。我们研究了生存的患者接受肝切除术，这种疾病。研究设计：在1984年和1995年之间，我们评估了38例肝转移的神经内分泌肿瘤，包括21类癌，13胰岛细胞，和4个非典型神经内分泌肿瘤。对前瞻性和回顾性数据库以及肿瘤登记处的数据进行了分析。在这些患者中，15例接受了所有已知疾病的完全切除。其余23名患者也有局限于肝脏的疾病，肿瘤负荷相当，但被认为是不可切除的。这两组的长期生存率进行了compared.Results：接受肝切除的患者并没有显着差异，选择谁是不可切除的年龄，病理原发肿瘤部位，血清碱性磷酸酶水平，或肝脏参与的百分比。所有切除均完整，无残留病变，包括肺叶切除术（n = 3），肺段切除术（n = 1）和楔形切除术（n = 11），无手术死亡。接受肝切除的患者比未切除的患者生存期明显延长。虽然切除患者的中位生存期尚未达到，但不可切除组的中位生存期为27个月。接受肝切除术的患者有较高的5年生存率（73%对29%）。结论：肝切除术在选定的患者孤立性肝转移神经内分泌肿瘤可能延长生存。这一结论是通过比较我们的切除组与具有相似肿瘤负荷的不可切除组得出的。（J Am Cell Surg 1998;187：88-93. (C)1998年由美国外科医生学会出版）。
Background: Neuroendocrine tumors commonly metastasize to the liver. Although surgical resection is considered a treatment option for patients with localized metastases confined to the liver, the longterm survival benefit of liver resection has not been clearly demonstrated. We examined the survival of patients undergoing liver resection for this disease.Study Design: Between 1984 and 1995, we evaluated 38 patients with liver-only metastases from neuroendocrine tumors, including 21 carcinoid, 13 islet cell, and 4 atypical neuroendocrine neoplasms. Data from a combined prospective and retrospective database and a tumor registry were analyzed. Of these patients, 15 underwent complete resection of all known disease. The remaining 23 patients, who also had disease confined to the liver, had comparable tumor burden but were believed to be unresectable. The longterm survival rates of these two groups were compared.Results: Patients who underwent Liver resection did not differ from chose who were unresectable with regard to age, pathology primary tumor site, serum alkaline phosphatase levels, or percentage of the liver involved. All resections were complete, leaving no residual disease, and consisted of lobectomy (n = 3), segmentectomy (n = 1), and wedge resections (n = 11), There were no operative deaths. Patients who underwent hepatic resection had a significantly longer survival than unresected patients. Although median survival had not been reached in resected patients, the median survival in the unresectable group was 27 months. Patients who underwent liver resection had a higher 5-year actuarial survival (73% versus 29%).Conclusions: Hepatic resection in selected patients with isolated liver metastases from meuroendocrine tumors may prolong survival. This conclusion was reached by comparing our resected group with an unresectable group with similar tumor burden. (J Am Cell Surg 1998;187:88-93. (C) 1998 by the American College of Surgeons).