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Oligometastasierung bei neuroendokrinen Tumoren – Ausmaß der Chirurgie

Oligometastases of neuroendocrine tumors—extent of surgery

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Zusammenfassung

Neuroendokrine Tumoren (NET) sind seltene Neoplasien, die komplexe Herausforderungen an Diagnose und Behandlung stellen. Selbst im metastasierten Stadium gibt es wichtige Unterschiede in der Art dieser Tumoren im Vergleich zu gastrointestinalen und pankreatischen Adenokarzinomen. So unterscheiden sich die Krankheitsverläufe ja nach Differenzierungsgrad erheblich. Auch im metastasierten Stadium liegt bei G1-Tumoren das 5‑Jahres-Überleben bei bis zu 83 %. Ungefähr 20 % der Dünndarm-NET weisen zusätzlich eine Hormonaktivität auf, die das Überleben und die Lebensqualität zusätzlich beeinflussen kann. Bei der individuellen Therapieentscheidung muss daher die spezielle Tumorbiologie dieser Tumoren, mehr als bei anderen Tumorentitäten, Berücksichtigung finden. Die Chirurgie kommt bei diesen Tumoren immer dann zum Tragen, wenn eine R0-Resektion möglich erscheint. Eine Oligometastasierung der Leber und des Lymphabflusssystems kann sinnvoll chirurgisch angegangen werden. Bei ausgewählten Patienten kann bei einem isolierten Befall der Leber eine Lebertransplantation erwogen werden. Aber auch Tumordebulking kann vor allem bei hormonaktiven Tumoren mit einem konservativ nicht beherrschbaren Karzinoidsyndrom zur Verbesserung der Lebensqualität und des Überlebens führen. Diese Übersichtsarbeit stellt den Stellenwert der chirurgischen Behandlungsoptionen beim (oligo)metastasierten NET dar.

Abstract

Neuroendocrine tumors (NETs) are rare neoplasms, which represent complex challenges in diagnosis and treatment. Even in the metastatic stage there are important differences in the type of tumor in comparison to gastrointestinal and pancreatic adenocarcinomas. Therefore, the disease courses are substantially different depending on the grade of differentiation. Even in the metastatic stage the 5‑year survival rates of G1 tumors is up to 83%. Approximately 20% of small intestine NETs additionally show hormone activity, which can compromise survival and the quality of life. For individual treatment decisions the special tumor biology of these tumors must be taken into consideration more so than for other tumor entities. Surgery always becomes important for these tumors when a R0 resection appears possible. Oligometastasis of the liver and the lymph drainage system can be meaningfully approached by surgical treatment. In selected patients with an isolated liver involvement, a liver transplantation can be considered; however, even tumor debulking can lead to improvement in the quality of life and survival, especially for hormone active tumors with a carcinoid syndrome which cannot be conservatively controlled. The aim of this review is to present the value of surgical treatment options in the case of (oligo)metastasized NETs.

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Abb. 1

Abbreviations

ALPPS:

„Associating Liver Partition and Portal Vein Ligation“

CCR:

„Completeness of cytoreduction“

CT:

Computertomographie

ENETS:

European Neuroendocrine Tumor Society

GEP-NET:

Gastroenteropankreatischer neuroendokriner Tumor

GPS:

Abdominal gravity PC score

HIPEC:

Hypertherme intraperitonale Chemoperfusion

LTx:

Lebertransplantation

MRT:

Magnetresonanztomographie

NET:

Neuroendokriner Tumor

PC:

Peritonealkarzinose

PET:

Positronenemissionstomographie

PRRT:

Peptidvermittelte Radiorezeptortherapie

RFA:

Radiofrequenzablation

RPVE:

Embolisation der rechten Pfortader

RPVL:

Ligatur der rechten Pfortader

SE:

„Standard Exception“

SIRT:

Selektive interne Radiotherapie

TACE:

Transarterielle Chemoembolisation

UNOS:

United Network for Organ Sharing

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland

    F. Bösch, J. Werner, M. K. Angele &  M. O. Guba

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Correspondence to F. Bösch.

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F. Bösch, J. Werner, M.K. Angele und M.O. Guba geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bösch, F., Werner, J., Angele, M.K. et al. Oligometastasierung bei neuroendokrinen Tumoren – Ausmaß der Chirurgie. Chirurg 89, 516–522 (2018). https://doi.org/10.1007/s00104-018-0644-z

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