Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5064-5072
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5064
Microwave ablation combined with hepatectomy for treatment of neuroendocrine tumor liver metastases
Jin-Zhu Zhang, Shu Li, Wei-Hua Zhu, Da-Fang Zhang
Jin-Zhu Zhang, Shu Li, Wei-Hua Zhu, Da-Fang Zhang, Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
Author contributions: Zhang JZ designed the study, acquired and analyzed the data, and wrote the paper; Li S acquired and analyzed the data, and revised the paper; Zhu WH acquired and analyzed the data, and revised the paper; Zhang DF designed the study, revised the paper, and supervised the study.
Supported by Peking University People’s Hospital Scientific Research Development Funds, No. RDY2017-28.
Institutional review board statement: The study was reviewed and approved by the Peking University People’s Hospital Institutional Review Board (No. 2020PHB334-01).
Informed consent statement: Patients were not required to give informed consent to the stud because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Da-Fang Zhang, MD, PhD, Associate Chief Physician, Associate Professor, Surgeon, Department of Hepatobiliary Surgery, Peking University People's Hospital, No. 11 South Street, West Straight Gate, Beijing 100044, China. zhangdafang03868@pkuph.edu.cn
Received: January 14, 2021
Peer-review started: January 14, 2021
First decision: April 4, 2021
Revised: April 13, 2021
Accepted: May 6, 2021
Article in press: May 6, 2021
Published online: July 6, 2021
Processing time: 161 Days and 2.9 Hours
Abstract
BACKGROUND

Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases. However, most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy. Ablation combined with hepatectomy can be an alternative to liver resection.

AIM

To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.

METHODS

In this study, the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed. Before the operation, the patients did not receive any treatment for liver neuroendocrine tumors. After a multidisciplinary expert group discussion, all patients were deemed unsuitable for liver resection. All patients were diagnosed with neuroendocrine tumors by pathology. The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.

RESULTS

Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018. The median number of liver metastatic nodules was 4 (range, 2 to 43). The median number of lesions resected was 1 (range, 1 to 18), and the median number of lesions ablated was 3 (range, 1 to 38). The mean operation time was 405.6 (± 39.4) min. The median intraoperative blood loss was 600 mL (range, 50 to 3000). Ten patients had a fever after surgery. The median duration of fever was 3 d (range, 0 to 21). Elevated bilirubin levels occurred in all patients after surgery. The median bilirubin on the first day after surgery was 28.5 (range, 10.7 to 98.9) µmol/L. One patient developed respiratory failure, renal insufficiency, and pneumonia after the operation. No patient died postoperatively during hospitalization. The mean overall survival time after surgery was 34.1 (± 3.7) mo, and the median progression-free survival time was 8 (range, 2 to 51) mo. One year after surgery, ten patients survived and five patients survived without progression. Three year after surgery, eight patients survived and two patients survived without progression.

CONCLUSION

Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy, but also has a low incidence of postoperative complications.

Keywords: Liver; Neoplasm metastasis; Microwave; Hepatectomy; Neoplasm; Endocrine tumor

Core Tip: Liver resection is the first choice for treating neuroendocrine tumor liver metastases. Due to the strict indications for hepatectomy, most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy. Ablation combined with hepatectomy is an alternative treatment option. Here, this study analyzed the clinical effect of microwave ablation combined with hepatectomy in the treatment of neuroendocrine tumor liver metastases. The results show that microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy, but also has a low incidence of postoperative complications.