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World Journal of Surgery

, Volume 19, Issue 1, pp 76–82 | Cite as

Neuroendocrine metastases of the liver

  • Ingemar Ihse
  • Bo Persson
  • Sten Tibblin
Article

Abstract

Neuroendocrine liver metastases are rare, yet they represent an entity that has attracted much attention lately. The protracted course of neuroendocrine tumors and the hormone origin of their typical incapacitating symptoms constitute a logical basis for well founded and bespoke treatment. Demonstration of the liver secondaries is best done by ultrasonography (US) and contrast-enhanced computed tomography (CT), which on the whole have replaced the invasive angiography techniques. By use of histochemical and molecular biologic methods the exact nature of the tumor can be typified in tissue samples obtained percutaneously, laparoscopically, or surgically. Localization of nonpalpable metastases of the liver is best done by intraoperative US. Surgical removal of liver metastases is curative in some cases and is usually effective in relieving the symptoms. Also, palliative debulking or cytoreductive surgery is often worthwhile as it offers a chance of prolonged survival and symptom relief. Similar benefits are achieved by ischemic therapy preferably by temporary dearterialization, which in our department is done on an outpatient basis using a specially designed (externally controlled) occluder applied during a single laparotomy that includes debulking when appropriate as well as cholecystectomy. Hormonal therapy with somatostatin analogs may be used as a single treatment or in combination with ischemic therapy. It has an ensured symptom-reducing effect, whereas its influence on tumor growth is unsettled. Lately similar effects have been ascribed to human leukocyte interferon. In conclusion the specific characteristics of neuroendocrine tumors and the available treatment arsenal favor an active treatment approach in patients who have developed liver metastases.

Keywords

Liver Metastasis Neuroendocrine Tumor Molecular Biologic Method Develop Liver Metastasis Human Leukocyte Interferon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Les métastases d'origine neuroendocrine sont rares, mais elles sollicitent beaucoup d'attention, surtout depuis peu de temps. L'évolution habituellement prolongée et l'origine hormonale des symptômes sont deux arguments bien connus pour souligner l'intérêt d'un traitement agressif. Mettre en évidence de telles métastases se fait au mieux par l'échographie et la tomodensitométric avec injection de produit de contraste, qui ont pratiquement remplacé les techniques d'artériographie. En utilisant des techniques d'histochimie et de biologie moléculaire, on peut déterminer facilement l'origine exacte des tissus tumoraux obtenus par biopsic percutanée, par laparoscopie ou par chirurgie. La localisation des tumeurs non palpables se fait au mieux par l'échographie. L'exérèse de ces métastases peut dans certains cas être un geste curatif et soulage souvent les symptômes en rapport. L'exérèse ou la chirurgie cytoréductrice, même incomplète, est également souvent suivie d'une amélioration des symptômes et d'une prolongation de la survie. L'ischémie provoquée de ces tumeurs, habituellement par desartérialisation temporaire, est effectuée dans notre département en externe en utilisant un système occlusif (contrôlé par voie externe), conçu spécialement dans ce but, et inséré habituellement lors de la laparotomie de réduction tumorale. On effectue également une cholécystectomie dans le même temps opératoire. On peut aussi utiliser des analogues de la somatostatine, soit isolément soit en association avec l'ischémie provoquée des métastases. Cette thérapeutique a une action certaine sur les symptômes mais son effect sur la croissance tumorale reste un sujet de débat. On a dernièrement décrit des effects similaires en utilisant l'interféron des leucocytes humains. En conclusion, les caractéristiques spécifiques de ces tumeurs neuroendocrines et l'arsenal thérapeutique disponible à présent sont autant d'arguments en faveur d'un traitement actif, même chez le patient qui a développé des métastases hépatiques.

Resumen

Las metástasis hepáticas de tumores neuroendocrinos son raras; sin embargo, representan una entidad que ha atraído considerable atención en tiempos recientes. La evolución prolongada y lenta de los tumores neuroendocrinos y el origen típicamente hormonal de sus incapacitantes síntomas constituyen una base lógica para un tratamiento racional y bien fundamentado. La demostración de las lesiones secundarias en el hígado se logra en forma óptima mediante ultrasonografía (US) y tomografía computadorizada con contraste (CT), técnicas que han desplazado las de angiografía invasora. Mediante métodos histoquímicos y de biología molecular se puede identificar la naturaleza exacta del tumor en tejido obtenido por acceso percutáneo, laparoscópico o quirúrgico. En el curso de la cirugía, la localización de las metástasis no palpables del hígado se logra mejor por medio de la US intraoperatoria. La remoción quirúrgica de las metástasis puede resultar curativa en muchos casos y generalmente es eficaz en cuanto al control de los síntomas. Así mismo, la cirugía paliativa de debultamiento o citoreducción es con frecuencia de utilidad al ofrecer una oportunidad de prolongar la sobrevida y de controlar la sintomatología. Efectos benéficos similares pueden ser logrados por la terapia isquémica, preferencialmente por desarterilización temporal, método que en nuestro departamento se realiza como procedimiento ambulatorio utilizando un sistema que es aplicado en el curso de una laparotomía única, durante la cual se practica debultamiento y colecistectomía según estén indicados. La terapia hormonal con análogos de la somastotatina puede ser utilizada tanto como modalidad única de tratamiento o en combinación con terapia isquémica. Aunque exhibe una garantía en lo referente a reducción de sintomatología, no está bien definido su efecto sobre el crecimiento del tumor. Ultimamente se han informado efectos similares con el interferón leucocítico humano. En conclusión, las características específicas de los tumores neuroendocrinos y la disponibilidad de un verdadero arsenal terapéutico, favorece un enfoque de tratamiento activo aun en pacientes que hayan desarrollado metástasis hepáticas.

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Copyright information

© Société Internationale de Chirurgie 1995

Authors and Affiliations

  • Ingemar Ihse
    • 1
  • Bo Persson
    • 1
  • Sten Tibblin
    • 1
  1. 1.Department of SurgeryUniversity Hospital, Lund UniversityLundSweden

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