Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2018
[Role of visceral surgery in oligometastases of non-gastrointestinal tumors].
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Wahba R, Stippel D, Bruns C
Аннотация
BACKGROUND: Patients with oligometastatic disease can benefit from local treatment of the metastases. Under these premises the resection of liver metastases and visceral metastases of non-gastrointestinal tumors is performed increasingly more frequently in selected patients. The aim of this study was to evaluate the role of visceral oncological surgery in hepatic oligometastatic disease of non-gastrointestinal tumors according to the currently available literature.
MATERIAL AND METHODS: A systematic search of MEDLINE and PubMed was carried out focusing on the topics of oligometastases, liver resection and metastectomy for breast cancer, renal cell carcinoma, malignant melanoma, ovarian cancer and non-small cell lung cancer.
RESULTS: The evidence is limited to retrospective studies and case series. In selected patients after liver resection and multimodal therapy 5‑year survival rates of 53% (breast cancer), 62% (renal cell carcinoma), 22% (malignant melanoma) and 50% (ovarian cancer) are described. For lung cancer (NSCLC) median survival was 12 month. Prognostic factors n were a disease free survival of >12 months, R0-resection, response to systemic therapy and extra hepatic/extra abdominal metastases. These could be selection criteria for liver resection. Recurrence liver resection, resection of the pancreas and cytoreductive surgery including multivisceral resection (ovarian cancer) could also improve survival.
CONCLUSION: Regarding limited evidence patients with oligometastatic disease origin from non-gastrointestinal tumors could benefit from liver resection. Tumor biology and response to targeted individualized systemic therapy become more important in this scenario.
MATERIAL AND METHODS: A systematic search of MEDLINE and PubMed was carried out focusing on the topics of oligometastases, liver resection and metastectomy for breast cancer, renal cell carcinoma, malignant melanoma, ovarian cancer and non-small cell lung cancer.
RESULTS: The evidence is limited to retrospective studies and case series. In selected patients after liver resection and multimodal therapy 5‑year survival rates of 53% (breast cancer), 62% (renal cell carcinoma), 22% (malignant melanoma) and 50% (ovarian cancer) are described. For lung cancer (NSCLC) median survival was 12 month. Prognostic factors n were a disease free survival of >12 months, R0-resection, response to systemic therapy and extra hepatic/extra abdominal metastases. These could be selection criteria for liver resection. Recurrence liver resection, resection of the pancreas and cytoreductive surgery including multivisceral resection (ovarian cancer) could also improve survival.
CONCLUSION: Regarding limited evidence patients with oligometastatic disease origin from non-gastrointestinal tumors could benefit from liver resection. Tumor biology and response to targeted individualized systemic therapy become more important in this scenario.