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Radioembolization for neuroendocrine liver metastases is safe and effective prior to major hepatic resection

摘要Background: Radioembolization (RE) is well established in the treatment of neuroendocrine liver metastases. However surgery is rarely performed after RE, although liver resection is the gold standard in the treatment of localized neuroendocrine liver metastases. Therefore, aim of the present study was to evaluate the safety and feasibility of liver resection after RE in a homogenous cohort. Methods: From a prospective surgical (n=494) and nuclear medical (n=138) database patients with NELM who underwent liver resection and/or RE were evaluated. Between September 2011 and December 2017 eight patients could be identified who underwent liver resection after RE (mean therapeutic activity of 1,746 Mbq). Overall and progression free survival were evaluated as well as epidemiological and perioperative factors. The surgical specimens were analyzed for necrosis, fibrosis, inflammation, and steatosis. Results: The mean hepatic tumor load of patients, who had liver surgery after RE, was 31.4% with a mean Ki-67 proliferation index of 5.9%. The majority of these patients (7/8) received whole liver RE prior to liver resection, which did not increase morbidity and mortality compared to a surgical collective. Indications for RE were oncological (6/8) or carcinoid syndrome associated reasons (2/8). Mean overall survival was 25.1 months after RE and subsequent surgery. Tumor necrosis in radioembolized lesions was 29.4% without evidence of fibrosis and inflammation in hepatic tissue. Conclusions: This is the first study analyzing the multimodal therapeutic approach of liver resection following whole liver RE. This treatment algorithm is safe, does not lead to an increased morbidity and is associated with a favorable oncological outcome. Nonetheless, patient selection remains a key issue.

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作者 Florian B?sch [1] Harun Ilhan [2] Vanessa Pfahler [3] Michael Thomas [1] Thomas Kn?sel [4] Valentin Eibl [1] Sebastian Pratschke [1] Peter Bartenstein [2] Max Seidensticker [3] Christoph J. Auernhammer [5] Christine Spitzweg [5] Markus O. Guba [1] Jens Werner [1] Martin K. Angele [1] 学术成果认领
作者单位 Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany;Interdisciplinary Center of Neuroendocrine Tumors of the Gastro Entero Pancreatic System, Ludwig-Maximilians-University Munich, Munich, Germany [1] Interdisciplinary Center of Neuroendocrine Tumors of the Gastro Entero Pancreatic System, Ludwig-Maximilians-University Munich, Munich, Germany;Department of Nuclear Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany [2] Interdisciplinary Center of Neuroendocrine Tumors of the Gastro Entero Pancreatic System, Ludwig-Maximilians-University Munich, Munich, Germany;Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany [3] Interdisciplinary Center of Neuroendocrine Tumors of the Gastro Entero Pancreatic System, Ludwig-Maximilians-University Munich, Munich, Germany;Institute of Pathology, Ludwig-Maximilians-University Munich, Munich, Germany [4] Interdisciplinary Center of Neuroendocrine Tumors of the Gastro Entero Pancreatic System, Ludwig-Maximilians-University Munich, Munich, Germany;Department of Internal Medicine 4, Ludwig-Maximilians-University Munich, Munich, Germany [5]
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DOI 10.21037/hbsn.2019.07.11
发布时间 2020-08-20(万方平台首次上网日期,不代表论文的发表时间)
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