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Lebermetastasen neuroendokriner Tumoren

Liver metastases of neuroendocrine tumors

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Zusammenfassung

Neuroendokrine Lebermetastasen (NELM) sind in Bezug auf die klinische Präsentation und die Prognose sehr heterogen. Die Behandlung von NELM erfordert einen multidisziplinären Ansatz und Patienten mit NELM sollten an spezialisierte Zentren überwiesen werden. Die Resektion von NELM bietet, sofern durchführbar, die besten langfristigen Ergebnisse. Zu den allgemeinen Selektionskriterien für eine Leberresektion gehören ein für eine größere Leberoperation akzeptabler Allgemeinzustand, Tumoren mit günstiger Differenzierung Grad 1 oder 2, das Fehlen extrahepatischer Läsionen, ein suffizientes Restlebervolumen sowie die Möglichkeit, mindestens 70 % der Metastasen zu resezieren. Ergänzende Therapien, einschließlich der gleichzeitigen Leberablation, sind im Allgemeinen sicher und können die Zahl der für eine Operation infrage kommenden Patienten erhöhen. Bei Patienten mit resektablen NELM wird die Resektion des Primärtumors entweder in einem zweizeitigen oder kombinierten Verfahren empfohlen. Bei selektionierten Patienten mit irresektablen NELM kann eine Lebertransplantation erfolgen, welche mit exzellenten Langzeitergebnisse einhergehen kann.

Abstract

Neuroendocrine liver metastases (NELM) are very heterogeneous with respect to the clinical presentation and the prognosis. The treatment of NELMs requires a multidisciplinary approach and patients with NELM should be referred to a specialized center. When possible, the resection of NELMs provides the best long-term results. The general selection criteria for liver resection include an acceptable general physical condition for a large liver operation, tumors with a favorable differentiation grade 1 or 2, a lack of extrahepatic lesions, a sufficient residual liver volume and the possibility to resect at least 70% of the metastases. Supplementary treatment, including simultaneous liver ablation, are generally safe and can increase the number of patients who can be considered for surgery. For patients with resectable NELM, the resection of the primary tumor is recommended either in a 2-stage or combined procedure. In selected patients with nonresectable NELM a liver transplantation can be carried out, which can be associated with excellent long-term results.

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Abbreviations

CT:

Computertomographie

ENETS:

European Neuroendocrine Tumor Society

GEP-NEN:

Gastroenteropankreatische neuroendokrine Neoplasien

gNEN:

Gastrale neuroendokrine Neoplasien

iNEN:

Intestinale neuroendokrine Neoplasien

LT:

Lebertransplantation

MRT:

Magnetresonanztomographie

MWA:

Mikrowellenablation

NANETS:

North American Neuroendocrine Tumor Society

NEC:

Neuroendokrine Karzinome

NELM:

Neuroendokrine Lebermetastasen

NEN:

Neuroendokrine Neoplasien

NET:

Neuroendokrine Tumoren

PET:

Positronenemissionstomographie

pNEN:

Pankreatische neuroendokrine Neoplasien

PRRT:

Peptidrezeptorradionuklidtherapie

PVL:

Portalvenenligation

RE:

Radioembolisation

RFA:

Radiofrequenzablation

rNELM:

Rezidivierende neuroendokrine Lebermetastasen

SA:

Somatostatinanaloga

SEER:

Suveillance, Epidemiology, and End Results

siNEN:

Neuroendokrine Neoplasien des Dünndarms (small intestine)

TACE:

Transarterielle Chemoembolisation

TAE:

Transarterielle Embolisation

TARE:

Transarterielle Radioembolisation

UNOS:

United Network of Organ Sharing

US:

Ultraschall

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  1. Klinik für Allgemeine, Viszeral- Und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    S. Nadalin, M. Peters & A. Königsrainer

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Nadalin, S., Peters, M. & Königsrainer, A. Lebermetastasen neuroendokriner Tumoren. Chirurgie 93, 659–666 (2022). https://doi.org/10.1007/s00104-022-01656-1

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