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Liver resection versus other treatments for neuroendocrine tumours in patients with resectable liver metastases

  • Review
  • Intervention

Authors

  • Kurinchi Selvan Gurusamy,

    Corresponding author
    1. Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK
    • Kurinchi Selvan Gurusamy, University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

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  • Rajarajan Ramamoorthy,

    1. Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK
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  • Dinesh Sharma,

    1. Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK
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  • Brian R Davidson

    1. Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK
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Abstract

Background

Neuroendocrine tumours are tumours of cells, which possess secretory granules and originate from the neuroectoderm. While liver resection is generally advocated in patients with resectable liver metastases, recent studies have shown good survival in patients with disseminated neuroendocrine tumours who underwent thermal ablation using radiofrequency.

Objectives

To determine the benefits and harms of liver resection versus other treatments in patients with resectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded and LILACS until July 2008 for identifying the randomised trials.

Selection criteria

We considered only randomised clinical trials (irrespective of language, blinding, or publication status) comparing liver resection (alone or in combination with radiofrequency ablation or cryoablation) versus other interventions (chemotherapy, hormonotherapy, or immunotherapy) and those comparing liver resection and thermal ablation (radiofrequency ablation or cryoablation) in patients with resectable liver metastases from neuroendocrine tumours for the review.

Data collection and analysis

Two authors independently identified trials for inclusion.

Main results

We were unable to identify any randomised clinical trial suitable for inclusion in this review. We were also unable to identify any quasi-randomised studies, cohort studies, or case-control studies that could inform meaningfully.

Authors' conclusions

There is no evidence from randomised clinical trials comparing liver resection versus other treatments in patients with resectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours. Liver resection appears to be the main stay curative treatment for neuroendocrine liver metastases based on non-randomised studies. Further randomised clinical trials comparing liver resection alone or in combination with chemoembolisation or radionuclide therapy are needed. Further randomised clinical trials comparing surgical resection and radiofrequency ablation in selected patients may also be appropriate.

摘要

背景

肝臟切除對照其他療法治療肝轉移病人的神經內分泌腫瘤

神經內分泌腫瘤是指攜帶分泌顆粒的細胞腫瘤,起源於神經外胚層。一般建議對可切除肝轉移的病人實施肝臟切除,近期研究指出使用射頻療法治療轉移性神經內分泌腫瘤的病人之後能有不錯的存活率。

目標

判定肝臟切除對照其他療法治療起源於胃腸胰神經內分泌腫瘤的可切除肝轉移病人的利弊。

搜尋策略

我們搜尋截至2008年7月的The Cochrane HepatoBiliary Group Controlled Trials Register, The Cochrane Library,的Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE、EMBASE、 Science Citation Index Expanded和LILACS的相關隨機試驗。

選擇標準

我們只收錄比較肝臟切除(單獨或合併射頻療法或冷凍療法) 和其他入方法(化學治療,荷爾蒙治療或免疫療法)的隨機臨床試驗(不受語言,盲法或發表狀況的限制)。

資料收集與分析

2位作者各自決定收錄的試驗

主要結論

我們無法確定有適合本次文獻回顧收錄的隨機臨床試驗。 我們也無法找出半隨機研究、世代研究或個案對照研究來提供有意義之資訊。

作者結論

沒有任何隨機臨床試驗的證據來比較肝臟切除對照其他療法,治療來自因胃腸胰之神經內分泌腫瘤的可切除肝轉移的病人。根據非隨機研究,肝臟切除似乎是治療神經內分泌肝臟轉移的主要治療方法。 需要實施更多的單獨使用肝臟切除比照肝臟切除合併化療栓塞或核子醫學治療一起使用的隨機臨床試驗。同時應對已選中的病人進行針對實施手術切除對照射頻療法的隨機臨床試驗。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

由於腸道激素細胞發生激素癌變而導致的肝臟轉移一般使用肝臟切除手術治療 (移除肝臟被影響的部分) ,如果可行的話,該手術可以清除所有腫瘤的部分,並且具有良好的長期存活率。但是,最近有研究指出,針對無法肝臟切除的肝轉移病人使用射頻療法破壞腫瘤的手術具有好的存活率。本次Cochrane文獻回顧試圖回答是否手術切除肝臟腫瘤的方法比其他治療方式能有更好的治療效果。我們沒有找到相關的隨機臨床試驗。目前,沒有隨機臨床試驗提供肝臟切除對照其他療法治療因神經內分泌腫瘤引起的可切除肝轉移病人的資料。來自回溯性研究的證據指出,對病人實施手術切除具有較長的存活率。同時有些研究認為肝臟切除合併其他治療方式如外科手術合併,化學治療或核子醫學治療會得到比單獨實施手術有更高的存活率。最近研究發現,射頻療法(使用放射波的熱量摧毀腫瘤)有助於治療較小的腫瘤(大小不超過5 cm)的病人。但是,對於射頻療法術的長期追蹤資料目前仍沒有。根據非隨機研究發現,肝臟切除似乎是治療神經內分泌肝臟轉移的主要治療方法。需要實施更多的隨機臨床試驗比較肝臟切除比較單獨使用比照肝臟切除合併化療栓塞或核子醫學治療。同時應對已選中的病人進一步適當地實施手術切除對照射頻療法進行隨機臨床試驗。

Plain language summary

No evidence from randomised clinical trial for optimal management of resectable liver spread originating from intestinal hormone cells

Liver spread from hormone-producing cancer of intestinal hormone cells is generally treated by liver resection surgery (removing the affected parts of the liver) if it is possible to remove all the cancer deposits and is associated with good long-term survival. However, recently, destroying the tumour using radiofrequency waves has been reported to show reasonably good survival in patients in whom it is not possible to remove the liver spread by surgery. This Cochrane review attempted to answer the question whether surgical resection of the liver tumours is better than other forms of treatment in patients with removable liver spread. We could not find any randomised clinical trials addressing the issue. Currently, there is no evidence from randomised clinical trials comparing liver resection versus other treatments in patients with resectable liver spread originating from intestinal hormone cells. Evidence from retrospective studies has shown prolonged survival after surgery for such patients. There has also been some suggestion that combining treatments such as surgery and chemotherapy or radioactive tracer treatment results in better survival than surgery alone. Therapies such as radiofrequency ablation (heat destruction of the tumours using radiofrequency waves) have been recently evaluated as curative treatment and may be useful in patients with small tumours (smaller than 5 cm in size). However, long-term follow-up data from radiofrequency ablation is not available. Liver resection appears to be the main stay curative treatment for neuroendocrine liver metastases based on non-randomised studies. Further randomised clinical trials comparing liver resection alone or in combination with chemoembolisation or radionuclide therapy are needed. Further randomised clinical trials comparing liver resection and radiofrequency ablation in selected patients may also be appropriate.

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