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Chirurgische Therapie neuroendokriner Tumoren der Leber und der Gallengänge

Surgical treatment of neuroendocrine tumors—liver and bile ducts

  • Leitthema
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Zusammenfassung

Die Indikationsstellung zur operativen Therapie hepatisch metastasierter neuroendokriner Tumoren (NET) sollte in ein multidisziplinäres Therapiekonzept eingebettet sein. Eine klare Indikation liegt bei Patienten vor, bei denen ein radikales Vorgehen im Rahmen der chirurgisch-technischen Möglichkeiten zur Tumorfreiheit führt. Trotz hoher Rezidivraten im Langzeitverlauf legitimiert sich die Indikation zum leberchirurgische Eingriff durch Symptompalliation und Hinweise auf ein verbessertes Patientenüberleben bei gleichzeitig niedriger perioperativer Mortalität in spezialisierten Zentren. Auf dem Boden des Evidenzgrads der vorliegenden Studien ist der Indikationsbereich der palliativen Resektionen zur Tumormassenreduktion und Symptompalliation nicht abschließend bewertbar. Ähnliches gilt für Patienten mit hepatisch metastasierten asymptomatischen NET. Jedoch besteht ein Konsens, dass die Tumormassenreduktion um mehr als 90% sinnvoll ist, wenn mit der konservativen Behandlung nur eine unzureichende Palliation erzielt werden kann. Die Indikation zur Lebertransplantation muss restriktiv gehandhabt werden und beschränkt sich auf Einzelfälle.

Abstract

The indication for surgery for liver metastases from neuroendocrine tumors (NET) should be embedded in a multidisciplinary approach. There is a clear indication in patients in whom radical resection with curative intent is technically feasible. Despite high recurrence rates in the long run, the indication for liver resection is legitimated by the palliation of symptoms and the chance for cure. Improved long-term survival and concomitantly low perioperative mortality have been demonstrated in specialized centers. Based on the degree of evidence derived from published data, the indication for palliative resection, i.e., tumor mass reduction and palliation of symptoms, has not been finally confirmed. Accordingly, data do not conclusively prove a benefit for surgery in patients with liver metastases from asymptomatic NET. However, there is consensus about tumor mass reduction of more than 90% in patients without satisfactory palliation of symptoms by conservative therapy. Liver transplantation is indicated in very individual cases only and should be applied restrictively.

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Literatur

  1. Jensen RT (1999) Natural history of digestive endocrine tumors. In: Mignon M, Colombel JF (eds) Recent advances in the pathophysiology and management of inflammatory bowel diseases and digestive endocrine tumors. John Libbey Eurotext, pp 192–219

  2. Bax NDS, Woods HF, Batchelor A, Jennings M (1996) Clinical manifestations of carcinoid disease. World J Surg 20:142–146

    Article  CAS  PubMed  Google Scholar 

  3. Que FG, Nagorney DM, Batts KP, Linz LJ, Kvols LK et al. (1995) Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg 169:36–42

    Article  CAS  PubMed  Google Scholar 

  4. Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG (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 

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

    CAS  PubMed  Google Scholar 

  6. Chamberlain RS, Canes D, Brown KT, Saltz L, Jarnagin W, Fong Y, Blumgart LH (2000) Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 190:432–445

    Article  CAS  PubMed  Google Scholar 

  7. Delcore R, Friesen SR (1994) Gastrointestinal neuroendocrine tumors. J Am Coll Surg 178:187–191

    CAS  PubMed  Google Scholar 

  8. Modlin IM, Lewis JJ, Ahlman H, Bilchik AJ, Kumar RR (1993) Management of unresectable malignant endocrine tumors of the pancreas. Surg Gyn Obstet 176:507

    CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Thompson GB, van Heerden JA, Grant CS et al. (1988) Islet cell carcinomas of the pancreas: a twenty-year experience. Surgery 104:1011–1017

    CAS  PubMed  Google Scholar 

  11. Dousset B, Saint-Marc O, Pitre J, Soubrane O, Houssin D, Chapuis Y (1996) Metastatic endocrine tumors: medical treatment, surgical resection, or liver transplantation. World J Surg 20:908–914

    Article  CAS  PubMed  Google Scholar 

  12. Ahlman H, Westberg G, Wangberg B, Nilsson O, Tylén U, Scherstén T, Tisell LE (1996) Treatment of liver metastasis of carcinoid tumors. World J Surg 20:196–202

    Article  CAS  PubMed  Google Scholar 

  13. Grazi GL, Cescon M, Pierangeli F, Ercolani G, Gardini A, Cavallari A, Mazziotti A (2000) Highly aggressive policy of hepatic resections for neuroendocrine liver metastases. Hepato-gastroenterology 47:481–486

    Google Scholar 

  14. Jaeck D, Oussoultzoglou E, Bachellier P, Lemarque P, Weber JC, Nakano H, Wolf P (2001) Hepatic metastases of gastroenteropancreatic neuroendocrine tumors: safe hepatic surgery. World J Surg 25:689–92

    Article  CAS  PubMed  Google Scholar 

  15. Nave H, Mossinger E, Feist H, Lang H, Raab H (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  CAS  PubMed  Google Scholar 

  16. Pascher A, Steinmuller T, Radke C, Hosten N, Wiedenmann B, Neuhaus P, Bechstein WO (2000) Primary and secondary hepatic manifestation of neuroendocrine tumors. Langenbecks Arch Surg 385:265–270

    Article  CAS  PubMed  Google Scholar 

  17. Chamberlain RS, Blumgart LH (1999) Carcinoid tumors of the extrahepatic bile duct. A rare cause of malignant biliary obstruction. Cancer 86:1959–1965

    Article  CAS  PubMed  Google Scholar 

  18. Kornberg A, Grube T, Wagner T, Homman M, Schotte U, Scheele J. Multivisceral transplantation for abdominal malignancy: indication, technique, and results in three patients. Transplant Proc 33:1558–1559

  19. Olausson M, Friman S, Cahlin C, Nilsson O, Jansson S, Wangberg B, Ahlman H (2002) Indications and results of liver transplantation in patients with neuroendocrine tumors. World J Surg 26:998–1004

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  21. Le Treut YP, Delpero JR, Dousset B, Cherqui D, Segol P, Mantion G, Hannoun L, Benhamou G, Launois B, Boillot O, Domergue J, Bismuth H (1997) Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report. Ann Surg 225/4:355–364

    Google Scholar 

  22. Lang H, Oldhafer KJ, Weimann A, et al. (1997) Liver transplantation for metastatic neuroendocrine tumors. Ann Surg 225/4:347–354

    Google Scholar 

  23. Bechstein WO, Neuhaus P (1994) Liver transplantation for hepatic metastases of neuroendocrine tumors. Ann NY Acad Sci 733:507–514

    CAS  PubMed  Google Scholar 

  24. Siperstein AE, Berber E (2001) Cryoablation, percutaneous alcohol injection, and radiofrequency ablation for treatment of neuroendocrine liver metastases. World J Surg 25:693–696

    Article  CAS  PubMed  Google Scholar 

  25. Knechtle SJ, Kalayoglu M, D’Alessandro AM, Rikkers LF (1997) Proceed with caution: Liver transplantation for metastatic neuroendocrine tumors. Ann Surg 225/4:345–346

    Google Scholar 

  26. Bechstein WO, Pascher A, Neuhaus P (1999) Liver transplantation in neuroendocrine tumors: which are the indications? In: Mignon M, Colombel JF (eds) Recent advances in the pathophysiology and management of inflammatory bowel diseases and digestive endocrine tumors. John Libbey Eurotext, pp 338–341

  27. Wiedenmann B, Jensen RT, Mignon M et al. (1998) Preoperative diagnosis and surgical management of neuroendocrine gastroenteropancreatic tumors: General recommendations by a Consensus Workshop. World J Surg 22:309–318

    Article  CAS  PubMed  Google Scholar 

  28. Scholzen T, Gerdes J (2000) The Ki-67 protein: from the known and the unknown. J Cell Physiol 182:311–22

    Article  CAS  PubMed  Google Scholar 

  29. Pelosi G, Bresaola E, Bogina G, Pasini F, Rodella S, Castelli P, lacono C, Serio G, Zamboni G (1996) Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy. Hum Pathol 27:1124–1134

    CAS  PubMed  Google Scholar 

  30. Rosenau J, Bahr MJ, von Wasielewski R, Mengel M, Schmidt HH, Nashan B, Lang H, Klempnauer J, Manns MP, Boeker KH (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  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Universitätsmedizin Berlin/Charité, Campus Virchow-Klinikum

    A. Pascher & P. Neuhaus

  2. Klinik für Allgemein-, Visceral- und Gefäßchirurgie, Vivantes Humboldt-Klinikum Berlin

    T. Steinmüller

  3. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Universitätsmedizin Berlin/Charité, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin

    A. Pascher

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  1. A. Pascher
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Correspondence to A. Pascher.

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Pascher, A., Steinmüller, T. & Neuhaus, P. Chirurgische Therapie neuroendokriner Tumoren der Leber und der Gallengänge. Onkologe 10, 1054–1060 (2004). https://doi.org/10.1007/s00761-004-0770-8

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  • DOI: https://doi.org/10.1007/s00761-004-0770-8

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