Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1260_Библиотеки_им_академика_М_И_Перельмана

In this comprehensive and important chapter, the authors concisely describe the presentation and treatment of noncolorectal liver metastases, providing sections on noncolorectal neuroendocrine and noncolorectal nonneuroendocrine liver metastases. Ten percent to 20% of patients with neuroendocrine tumors present with limited disease, making liver-directed therapy a viable treatment option. Debulking surgery for neuroendocrine liver metastases can allow for symptomatic relief and even prolong survival in some cases. Patients with neuroendocrine liver metastases are frequently good candidates for a minimally invasive resection although greater challenges regarding ultrasound detection of all disease exist. While disease almost always recurs, many patients may be candidates for repeat liver­directed therapy, which might be facilitated by a minimally invasive approach. Only limited evidence exists for resection of noncolorectal nonneuroendocrine liver metastases. While patients with unresectable disease often have dismal prognosis, in highly selected patients surgery may result in a long-term survival rate in the order of 30% at five years. Outcome is dependent on identifying patients with favorable tumor biology, which can be achieved through neoadjuvant chemotherapy and disease stability over a defined period of time. As the authors point out, a multidisciplinary approach is essential for optimal outcome.