Palliative cytoreductive surgery versus other palliative treatments in patients with unresectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours
Editorial Group: Cochrane Hepato-Biliary Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 17 JUL 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Gurusamy KS, Pamecha V, Sharma D, Davidson BR. Palliative cytoreductive surgery versus other palliative treatments in patients with unresectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007118. DOI: 10.1002/14651858.CD007118.pub2.
- Publication Status: New
- Published Online: 21 JAN 2009
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 alone metastases, the management of patients with liver metastases, which cannot be completely resected, is controversial.
To determine if cytoreductive surgery is better than other palliative treatments in patients with liver metastases from gastro-entero-pancreatic neuroendocrine tumours, which cannot be completely resected.
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.
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 palliative treatments (chemotherapy or hormone-therapy or immunotherapy) or no treatment in patients with liver metastases from neuroendocrine tumours, which cannot be completely resected, were considered for the review.
Data collection and analysis
Two authors independently identified trials for inclusion.
We were unable to identify any randomised clinical trial suitable for inclusion in this review.
The literature provides no evidence from randomised clinical trials in order to assess the role of cytoreductive surgery in non-resectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours. High-quality randomised clinical trials may become feasible to perform if their conduct and study design is thoroughly considered in all their practical and methodological aspects. Pilot randomised clinical trials, which can guide the study design of definitive randomised clinical trials, are necessary.
Plain language summary
No evidence for optimal management of patients with unresectable liver spread originating from intestinal hormone cells
Liver metastases (liver spread) from gastrointestinal neuroendocrine tumours (cancer of intestinal hormone cells which originate from the embryonic nerve cells or the embryonic outer coat) are generally treated with surgery if a complete removal is deemed possible. This is associated with a long-term survival. However, more than four-fifths of patients with liver metastases from neuroendocrine tumours cannot undergo resection of all metastatic disease. The treatment of such patients is controversial. Palliative removal of the liver spread (ie, leaving behind a part of the cancerous liver spread) or destroying a significant portion of the cancerous liver spread using radiofrequency waves (collectively called cytoreductive surgeries) are some of the options offering symptomatic relief and possible prolongation of survival. This Cochrane review attempted to answer the question of whether palliative cytoreductive surgery is better than other palliative treatments, but no randomised clinical trials were found, addressing this issue. High-quality randomised clinical trials may become feasible to perform if their conduct and study design is thoroughly considered in all their practical and methodological aspects. Pilot randomised clinical trials, which can guide the study design of definitive randomised clinical trials, are necessary.
我們搜尋截至2008年7月的The Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE、EMBASE、 Science Citation Index Expanded和LILACS，從而確認隨機試驗。
只有一次隨機臨床試驗(不受語言，盲法或發表狀況的限制)比較肝臟切除(單獨或合併射頻治療或腫瘤細胞減積術 和其他緩和性治療(化療或激素療法) 。
文獻資料沒有關於評估腫瘤細胞減積術對因胃、腸、胰、神經內分泌腫瘤引起的不可切除肝轉移的隨機臨床試驗證據。如果試驗的進行方式及研究設計有就研究方法及實務的觀點作通盤的考量，那麼這種高品質的隨機臨床試驗顯得可行。如果需要，先行隨機臨床試驗(pilot randomised clinical trials)可以引導具體隨機臨床試驗的研究設計。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
沒有證據指出最佳控制起源於腸道內分泌細胞的不可切除肝轉移的病人方法: 如果全部摘除可行，則對起源於胃腸神經內分泌腫瘤(腸道內分泌細胞癌變，起源於胚胎神經細胞或胚胎外層)的肝轉移一般使用手術治療。這種治療一般和長期存活率相關。但是，4/5以上的神經內分泌腫瘤肝轉移病人不能忍受所有轉移性疾病的切除手術。 人們對於此類病人的治療方法存有爭議。採用射頻電波(統稱為腫瘤細胞減積術)的緩和性摘除肝轉移手術(例如，留下一部分的癌變肝轉移) 或破壞一大部分的癌變肝轉移均屬於治療選擇，這些療法緩解症狀，可能也延長了存活時間。本次Cochrane系統性文獻回顧試圖回答是否緩和性減積手術優於其他緩和療法的問題，但是沒有發現提到此問題的隨機臨床試驗。如果試驗的進行方式及研究設計有就研究方法及實務的觀點作通盤的考量，那麼這種高品質的隨機臨床試驗顯得可行。如果需要，先行隨機臨床試驗(pilot randomised clinical trials)可以引導具體隨機臨床試驗的研究設計。