Tumor surgery in this field is no longer such a high risk as previously. Prolonged survival can be achieved by resection of hepatocellular carcinomas in non-cirrhotic livers (3-year survival 58%, n = 54 patients) and for colorectal liver metastases (3-year survival 44%, n = 124 patients). But surgery is rarely successful for the most frequent type of liver malignancy, the hepatocellular carcinoma in cirrhosis. Central bile duct carcinomas are now resected more frequently than in the past. Liver grafting seems indicated in special cases of liver and bile duct tumors. The future developments of operating on the in situ-perfused liver was discussed and the first operation on an ex situ-liver was demonstrated.
A novel quantitative liver function test is described which is based on monoethylglycinexylidide (MEGX) formation after lidocaine bolus injection. Following the administration of small single doses of lidocaine hydrochloride (l mg/kg), monoethylglycinexylidide serum concentration-time curves were determined by a novel highly sensitive fluorescence Polarisation immunoassay (FPIA) in healthy volunteers, liver donors and patients with liver cirrhosis. The FPIA allowed rapid and reliable monoethylglycinexylidide determinations in serum and urine (between-days coefficient of Variation: < 10.3%, recovery: 80-113%). Monoethylglyci-1 Preliminary results of this study were presented at the Third Meeting of the German Association för the Study of the Liver in
ObjectiveThis article describes the experience with liver transplantation in patients with irresectable neuroendocrine hepatic metastases.
Summary Background DataLiver transplantation has become an established therapy in primary liver cancer. On contrast, there is little experience with liver transplantation in secondary hepatic tumors. So far, in the majority of patients being transplanted for irresectable liver metastases, long-term results have been disappointing because of early tumor recurrence. Because of their biologically less aggressive nature, the metastases of neuroendocrine tumors could represent a justified indication for liver grafting.
MethodsIn a retrospective study, the data of 12 patients who underwent liver transplantation for irresectable neuroendocrine hepatic metastases were analyzed regarding survival, tumor recurrence, and symptomatic relief.
ResultsNine of 12 patients currently are alive with a median survival of 55 months (range, 1 1.0 days to 103.5 months). The operative mortality was 1 of 12, 2 patients died because of septic complications or tumor recurrences or both 6.5 months and 68.0 months after transplantation. All patients had good symptomatic relief after hepatectomy and transplantation. Four of the nine patients who are alive have no evidence of tumor with a follow-up of 2.0, 57.0, 58.0, and 103.5 months after transplantation.
ConclusionsIn selected patients, liver transplantation for irresectable neuroendocrine hepatic metastases may provide not only long-term palliation but even cure. Regarding the shortage of donor organs, liver grafting for neuroendocrine metastases should be considered solely in patients without evidence of extrahepatic tumor manifestation and in whom all other treatment methods are no longer effective.
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