肝移植在非结直肠肝转移中有作用吗?

Viszeralmedizin Pub Date : 2015-11-23 DOI:10.1159/000441237
U. Herden, B. Nashan
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引用次数: 2

摘要

由于血流量大,尤其是肠道经门静脉的血流量大,肝脏是转移的首选器官。在晚期,不可切除的肝转移病例中,肝移植(LTX)仍然是一个有吸引力的选择。然而,由于高复发率或缺乏数据,迄今为止,神经内分泌肿瘤(NETs)转移是唯一接受的非结直肠肝转移的LTX适应症。在这方面,LTX仅适用于可实现NET完全切除(R0切除)的患者。文献回顾显示没有明确的患者选择标准,但移植应该明确实现R0切除,肿瘤完全自由。现有数据显示,对于因其他恶性肿瘤(如肝细胞癌)或在高MELD(终末期肝病模型)时代的良性适应症而接受肝移植的患者,LTX治疗后的短期和长期结果相当。因此,大多数数据证明,肿瘤分化良好、增殖指数低(Ki67)、门静脉网引流的患者移植后预后较好,复发率较低。
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Is There a Role for Liver Transplantation in Non-Colorectal Liver Metastases?
Due to the high blood flow, especially blood from the intestinal tract via the portal vein, the liver is a preferred organ for metastases. In case of advanced, irresectable liver metastases liver transplantation (LTX) remains an attractive option. However, due to high recurrence rates or a lack of data, up to date, metastases from neuroendocrine tumors (NETs) are the only accepted indication for LTX in non-colorectal liver metastases. In this regard, LTX is only justified in patients in which complete tumor resection (R0 resection) of the NET is achievable. A literature review revealed no clear patient selection criteria but transplantation should definitively achieve an R0 resection with complete freedom of tumor. The available data regarding the outcome following LTX for NETs show a comparable short- and long-term outcome for patients transplanted for other malignancies, e.g. hepatocellular carcinoma, or also benign indications in the high MELD (model for end-stage liver disease) era. Thus, most data prove a better post-transplant outcome and a lower recurrence rate in patients with a good differentiation of the tumor, a low proliferation index (Ki67), and a portal drainage of the NET.
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来源期刊
Viszeralmedizin
Viszeralmedizin GASTROENTEROLOGY & HEPATOLOGY-SURGERY
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期刊最新文献
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