Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival
Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival
复制标题
DOI：
10.1016/j.surg.2007.01.036
复制
发表时间：
2007-07-01
期刊：
影响因子：
3.8
通讯作者：
Siperstein, Aflan E.
中科院分区：
文献类型：
--
作者：
Mazzaglia, Peter J.;Berber, Eren;Siperstein, Aflan E.
背景：十年前，我们报道了首次使用腹腔镜射频热消融（RFA）治疗神经内分泌性肝转移。这项研究分析了我们10年的经验，并确定了预测生存的特征。方法：在一项前瞻性试验中，对63例神经内分泌性肝转移患者进行80次RFA治疗。所有患者都有不可切除的疾病，并有计算机断层扫描（CT）记录病变和/或症状进展。分析围手术期发病率、症状缓解、病情进展和长期生存率。数据表示为平均值+/-平均值的标准误差（SEM）。结果：女性22例，男性41例，年龄54.4±1.5岁，随访2.8±0.3年（范围0.1 ~ 7.8）。肿瘤类型包括36例类癌、18例胰岛细胞癌和9例甲状腺髓样癌。肝转移诊断后1.6 +/- 0.3年行RFA。治疗病灶数为6 +/- 0.5（范围1 ~ 16）。49例患者接受了1次消融治疗，14例（22%）因疾病进展而重复消融治疗。平均住院时间1.1天。围手术期发病率为5%，无30天死亡率。57%的患者表现出症状。术后一周，92%的患者症状至少部分缓解，70%的患者症状明显或完全缓解。症状控制时间11 +/- 2.3个月。CT随访显示局部肿瘤复发率为6.3%。较大的显性肝肿瘤大小和男性对生存率有不利影响（P < 0.05）。原发肿瘤诊断后的中位生存时间为11.0年，神经内分泌肝转移诊断后的中位生存时间为5.5年，第一次RFA后的中位生存时间为3.9年。接受重复消融治疗的患者生存率没有显著降低。结论：本研究是RFA治疗的最大的神经内分泌肝转移瘤系列。本组患者有侵袭性神经内分泌肿瘤转移和有限的治疗，局部控制有效，症状迅速改善。选项，RFA提供有效的局部控制，并迅速改善症状。
Background: A decade ago we reported the first use of laparoscopic radiofrequency thermal ablation (RFA) for the treatment of neuroendocrine hepatic metastases. This study analyzes our 10-year experience and determines characteristics predictive of survival.Methods: Eighty RFA sessions were performed in 63 patients with neuroendocrine hepatic metastases in a prospective trial. All patients had unresectable disease with computed tomography (CT) documented lesion and/or symptom progression. Perioperative morbidity, symptom relief disease progression, and long-term survival were analyzed. Data are expressed as mean +/- standard error of the mean (SEM).Results: There were 22 women and 41 men, age 54.4 +/- 1.5 years followed for 2.8 +/- 0.3 years (range, 0.1 to 7.8). Tumor types included 36 carcinoid, 18 pancreatic islet cell, and 9 medullary thyroid cancer. RFA was performed 1.6 +/- 0.3 years after the diagnosis of liver metastases. Number of lesions treated was 6 +/- 0.5 (range, 1 to 16). Forty-nine patients underwent 1 ablation session, and 14 (22%) had repeat sessions caused by disease progression. Mean hospital stay was 1.1 days. Perioperative morbidity was 5%, with no 30-day mortality. Fifty-seven percent of patients exhibited symptoms. One week postoperatively 92% of these reported at least partial symptom relief, and 70% had significant or complete relief. Duration of symptom control was 11 +/- 2.3 months. CT follow-up demonstrated 6.3% local tumor recurrence. Larger dominant liver tumor size and male gender adversely impacted survival (P < .05). Median survival times were 11.0 years postdiagnosis of primary tumor, 5.5 years postdiagnosis of neuroendocrine hepatic metastases, and 3.9 years post-1st RFA. Survival for patients undergoing repeat ablation sessions was not significantly lower.Conclusions: This study represents the largest series of neuroendocrine hepatic metastases treated by RFA. In this group of patients with aggressive neuroendocrine tumor metastases and limited treatment effective local control with prompt symptomatic improvement. options, RFA provides effective local control with prompt symptomatic improvement.