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Indikatorisches und operatives Spektrum bei neuroendokrinen Lebermetastasen

Indications and operative procedures for neuroendocrine liver metastases

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Zusammenfassung

Die Entität der neuroendokrinen Tumoren (NET) umfasst hinsichtlich der Primärlokalisationen, des Metastasierungsmusters sowie der hormonellen Aktivität und des biologischen Wachstumsverhaltens sehr unterschiedliche Neoplasien. Prospektive Studien zur Effektivität chirurgischer Therapiekonzepte bei Lebermetastasen von NET fehlen weitgehend. Den meisten therapeutischen Empfehlungen lagen bislang kleinere retrospektive Serien mit oftmals heterogenen Patientengruppen zugrunde, welche nach nicht standardisierten und somit nicht vergleichbaren chirurgischen Konzepten behandelt wurden. Erst in den vergangenen Jahren sind Vorschläge für eine TNM-Klassifikation sowie für ein histologisches Grading erarbeitet worden, welche nun eine Risikostratifizierung bei NET erlauben. Insbesondere Patienten mit gut und mäßig differenzierten NET scheinen von der Resektion hepatischer Metastasen zu profitieren, wobei die 5-Jahres-Überlebensrate von weniger als 50% auf bis zu 80% gesteigert werden kann. Verbesserungen der bildgebenden Diagnostik und der intensivmedizinischen Betreuung sowie Innovationen auf dem Gebiet der Leberchirurgie erweitern die Anzahl der potenziell resektablen Tumoren. Lebertransplantationen können für streng selektierte Patienten ebenfalls zu einer Verbesserung der Prognose führen.

Abstract

Neuroendocrine malignancies encompass a variety of tumors that differ considerably in origin, hormonal activity, and biological behavior. Because of their rarity most therapeutic recommendations have been based on limited evidence from small retrospective series observing miscellaneous patient cohorts. Only in recent years proposals for TNM and histological grading systems have been elaborated that allow further stratification of patients suffering from these tumors. Especially patients with well and moderately differentiated neuroendocrine malignancies benefit from resection of liver metastases, improving the 5-year survival rate from <50% to 80%. Orthotopic liver transplantation can likewise improve survival in carefully selected patients. New developments in imaging modalities, intensive care treatment, and in liver surgery itself have broadened the selection of potentially resectable tumors.

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Literatur

  1. Ahlman H, Nilsson O, Mcnicol AM et al (2008) Poorly-differentiated endocrine carcinomas of midgut and hindgut origin. Neuroendocrinology 87:40–46

    Article  PubMed  CAS  Google Scholar 

  2. Bettini R, Boninsegna L, Mantovani W et al (2008) Prognostic factors at diagnosis and value of WHO classification in a mono-institutional series of 180 non-functioning pancreatic endocrine tumours. Ann Oncol 19:903–908

    Article  PubMed  CAS  Google Scholar 

  3. Bilimoria KY, Talamonti MS, Tomlinson JS et al (2008) Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors: analysis of 3851 patients. Ann Surg 247:490–500

    Article  PubMed  Google Scholar 

  4. Bonney GK, Gomez D, Rahman SH et al (2008) Results following surgical resection for malignant pancreatic neuroendocrine tumours. A single institutional experience. JOP 9:19–25

    PubMed  Google Scholar 

  5. Cahlin C, Friman S, Ahlman H et al (2003) Liver transplantation for metastatic neuroendocrine tumor disease. Transplant Proc 35:809–810

    Article  PubMed  CAS  Google Scholar 

  6. Carty SE, Jensen RT, Norton JA (1992) Prospective study of aggressive resection of metastatic pancreatic endocrine tumors. Surgery 112:1024–1031

    PubMed  CAS  Google Scholar 

  7. Chamberlain RS, Canes D, Brown KT et al (2000) Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 190:432–445

    Article  PubMed  CAS  Google Scholar 

  8. Chambers AJ, Pasieka Jl, Dixon E et al (2008) The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors. Surgery 144:645–651

    Article  PubMed  Google Scholar 

  9. Chen H, Hardacre JM, Uzar A et al (1998) Isolated liver metastases from neuroendocrine tumors: does resection prolong survival? J Am Coll Surg 187:88–92

    Article  PubMed  CAS  Google Scholar 

  10. Coppa J, Pulvirenti A, Schiavo M et al (2001) Resection versus transplantation for liver metastases from neuroendocrine tumors. Transplant Proc 33:1537–1539

    Article  PubMed  CAS  Google Scholar 

  11. Danforth DN Jr, Gorden P, Brennan MF (1984) Metastatic insulin-secreting carcinoma of the pancreas: clinical course and the role of surgery. Surgery 96:1027–1037

    PubMed  Google Scholar 

  12. Dousset B, Saint-Marc O, Pitre J et al (1996) Metastatic endocrine tumors: medical treatment, surgical resection, or liver transplantation. World J Surg 20:908–914

    Article  PubMed  CAS  Google Scholar 

  13. Elias D, Ouellet JF, De Baere T et al (2002) Preoperative selective portal vein embolization before hepatectomy for liver metastases: long-term results and impact on survival. Surgery 131:294–299

    Article  PubMed  Google Scholar 

  14. Eriksson J, Stalberg P, Nilsson A et al (2008) Surgery and radiofrequency ablation for treatment of liver metastases from midgut and foregut carcinoids and endocrine pancreatic tumors. World J Surg 32:930–938

    Article  PubMed  Google Scholar 

  15. Fernandez JA, Robles R, Marin C et al (2003) Role of liver transplantation in the management of metastatic neuroendocrine tumors. Transplant Proc 35:1832–1833

    Article  PubMed  CAS  Google Scholar 

  16. Florman S, Toure B, Kim L et al (2004) Liver transplantation for neuroendocrine tumors. J Gastrointest Surg 8:208–212

    Article  PubMed  Google Scholar 

  17. Forrer F, Waldherr C, Maecke HR et al (2006) Targeted radionuclide therapy with 90Y-DOTATOC in patients with neuroendocrine tumors. Anticancer Res 26:703–707

    PubMed  CAS  Google Scholar 

  18. Givi B, Pommier SJ, Thompson AK et al (2006) Operative resection of primary carcinoid neoplasms in patients with liver metastases yields significantly better survival. Surgery 140:891–898

    Article  PubMed  Google Scholar 

  19. Gomez D, Malik HZ, Al-Mukthar A et al (2007) Hepatic resection for metastatic gastrointestinal and pancreatic neuroendocrine tumours: outcome and prognostic predictors. HPB 9:345–351

    Article  PubMed  CAS  Google Scholar 

  20. Grover AC, Libutti SK, Pingpank JF et al (2004) Isolated hepatic perfusion for the treatment of patients with advanced liver metastases from pancreatic and gastrointestinal neuroendocrine neoplasms. Surgery 136:1176–1182

    Article  PubMed  Google Scholar 

  21. Gurusamy KS, Imber C, Davidson BR (2008) Management of the hepatic lymph nodes during resection of liver metastases from colorectal cancer: a systematic review. HPB Surg 684150

  22. Hemming AW, Reed AI, Howard RJ et al (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237:686–691

    Article  PubMed  Google Scholar 

  23. Hwang S, Lee YJ, Lee SG et al (2008) Surgical treatment of primary neuroendocrine tumors of the liver. J Gastrointest Surg 12:725–730

    Article  PubMed  Google Scholar 

  24. Jaeck D, Oussoultzoglou E, Bachellier P et al (2001) Hepatic metastases of gastroenteropancreatic neuroendocrine tumors: safe hepatic surgery. World J Surg 25:689–692

    Article  PubMed  CAS  Google Scholar 

  25. Knigge U, Hansen CP, Stadil F (2008) Interventional treatment of neuroendocrine liver metastases. Surgeon 6:232–239

    Article  PubMed  CAS  Google Scholar 

  26. Kuvshinoff B, Fong Y (2007) Surgical therapy of liver metastases. Semin Oncol 34:177–185

    Article  PubMed  Google Scholar 

  27. Lang H (2007) Liver resection: Part I. Anatomy and operative planning. Chirurg 78:761–774

    Article  PubMed  CAS  Google Scholar 

  28. Lang H, Oldhafer KJ, Weimann A et al (1997) Liver transplantation for metastatic neuroendocrine tumors. Ann Surg 225:347–354

    Article  PubMed  CAS  Google Scholar 

  29. Lang H, Schlitt HJ, Schmidt H et al (1999) Total hepatectomy and liver transplantation for metastatic neuroendocrine tumors of the pancreas – a single center experience with ten patients. Langenbeck’s Arch Surg 384:370–377

    Google Scholar 

  30. Le Treut YP, Delpero Jr, Dousset B et al (1997) Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report. Ann Surg 225:355–364

    Article  Google Scholar 

  31. Le Treut YP, Gregoire E, Belghiti J et al (2008) Predictors of long-term survival after liver transplantation for metastatic endocrine tumors: an 85-case French multicentric report. Am J Transplant 8:1205–1213

    Article  Google Scholar 

  32. Lehnert T (1998) Liver transplantation for metastatic neuroendocrine carcinoma: an analysis of 103 patients. Transplantation 66:1307–1312

    Article  PubMed  CAS  Google Scholar 

  33. Madeira I, Terris B, Voss M et al (1998) Prognostic factors in patients with endocrine tumours of the duodenopancreatic area. Gut 43:422–427

    Article  PubMed  CAS  Google Scholar 

  34. Makridis C, Oberg K, Juhlin C et al (1990) Surgical treatment of mid-gut carcinoid tumors. World J Surg 14:377–383

    Article  PubMed  CAS  Google Scholar 

  35. Martin JK Jr, Moertel CG, Adson MA et al (1983) Surgical treatment of functioning metastatic carcinoid tumors. Arch Surg 118:537–542

    PubMed  Google Scholar 

  36. Mazzaferro V, Pulvirenti A, Coppa J (2007) Neuroendocrine tumors metastatic to the liver: how to select patients for liver transplantation? J Hepatol 47:460–466

    Article  PubMed  Google Scholar 

  37. Mcentee GP, Nagorney DM, Kvols LK et al (1990) Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 108:1091–1096

    PubMed  CAS  Google Scholar 

  38. Modlin IM, Champaneria MC, Chan AK et al (2007) A three-decade analysis of 3,911 small intestinal neuroendocrine tumors: the rapid pace of no progress. Am J Gastroenterol 102:1464–1473

    Article  PubMed  Google Scholar 

  39. Modlin IM, Kidd M, Drozdov I et al (2008) Pharmacotherapy of neuroendocrine cancers. Expert Opin Pharmacother 9:2617–2626

    Article  PubMed  CAS  Google Scholar 

  40. Nagino M, Kamiya J, Nishio H et al (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372

    Article  PubMed  Google Scholar 

  41. Nave H, Mossinger E, Feist H et al (2001) Surgery as primary treatment in patients with liver metastases from carcinoid tumors: a retrospective, unicentric study over 13 years. Surgery 129:170–175

    Article  PubMed  CAS  Google Scholar 

  42. Nilsson O, Cutsem E Van, Delle Fave G et al (2006) Poorly differentiated carcinomas of the foregut (gastric, duodenal and pancreatic). Neuroendocrinology 84:212–215

    Article  PubMed  CAS  Google Scholar 

  43. Norton JA (2005) Endocrine tumours of the gastrointestinal tract. Surgical treatment of neuroendocrine metastases. Best Pract Res Clin Gastroenterol 19:577–583

    Article  PubMed  Google Scholar 

  44. Norton JA, Warren RS, Kelly MG et al (2003) Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 134:1057–1063

    Article  PubMed  Google Scholar 

  45. Olausson M, Friman S, Cahlin C et al (2002) Indications and results of liver transplantation in patients with neuroendocrine tumors. World J Surg 26:998–1004

    Article  PubMed  Google Scholar 

  46. Panzuto F, Nasoni S, Falconi M et al (2005) Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 12:1083–1092

    Article  PubMed  Google Scholar 

  47. Pape UF, Jann H, Muller-Nordhorn J et al (2008) Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors. Cancer 113:256–265

    Article  PubMed  Google Scholar 

  48. Que FG, Sarmiento JM, Nagorney DM (2006) Hepatic surgery for metastatic gastrointestinal neuroendocrine tumors. Adv Exp Med Biol 574:43–56

    Article  PubMed  Google Scholar 

  49. Ribero D, Abdalla EK, Madoff DC et al (2007) Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 94:1386–1394

    Article  PubMed  CAS  Google Scholar 

  50. Rindi G, Kloppel G, Alhman H et al (2006) TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 449:395–401

    Article  PubMed  CAS  Google Scholar 

  51. Rindi G, Kloppel G, Couvelard A et al (2007) TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 451:757–762

    Article  PubMed  CAS  Google Scholar 

  52. Rosenau J, Bahr MJ, Wasielewski R Von et al (2002) Ki67, E-cadherin and p53 as prognostic indicators of long-term outcome after liver transplantation for metastatic neuroendocrine tumors. Transplantation 73:386–394

    Article  PubMed  CAS  Google Scholar 

  53. Sarmiento JM, Heywood G, Rubin J et al (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37

    Article  PubMed  Google Scholar 

  54. Soreide O, Berstad T, Bakka A et al (1992) Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 111:48–54

    PubMed  CAS  Google Scholar 

  55. Steinmuller T, Kianmanesh R, Falconi M et al (2008) Consensus guidelines for the management of patients with liver metastases from digestive (neuro)endocrine tumors: foregut, midgut, hindgut and unknown primary. Neuroendocrinology 87:47–62

    Article  PubMed  CAS  Google Scholar 

  56. Tomassetti P, Campana D, Piscitelli L et al (2005) Endocrine pancreatic tumors: factors correlated with survival. Ann Oncol 16:1806–1810

    Article  PubMed  CAS  Google Scholar 

  57. Vilsteren FG Van, Baskin-Bey ES, Nagorney DM et al (2006) Liver transplantation for gastroenteropancreatic neuroendocrine cancers: Defining selection criteria to improve survival. Liver Transpl 12:448–456

    Article  PubMed  Google Scholar 

  58. Wicherts DA, De Haas RJ, Adam R (2007) Bringing unresectable liver disease to resection with curative intent. Eur J Surg Oncol 33 [Suppl 2]:42–51

    Google Scholar 

  59. Yao JC, Hassan M, Phan A et al (2008) One hundred years after „carcinoid“: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072

    Article  PubMed  Google Scholar 

  60. Yao KA, Talamonti MS, Nemcek A et al (2001) Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors. Surgery 130:677–682

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz, Langenbeck-Straße 1, 55101, Mainz, Deutschland

    T.J. Musholt &  H. Lang

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Musholt, T., Lang, H. Indikatorisches und operatives Spektrum bei neuroendokrinen Lebermetastasen. Chirurg 80, 113–121 (2009). https://doi.org/10.1007/s00104-008-1614-7

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