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"Cherry picking", a multiple non-anatomic liver resection technique, as a promising option for diffuse liver
Markus Krausch1, Andreas Raffel, Martin Anlauf
1Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany, krausch@med.uni-duesseldorf.de.
Introduction:
Liver metastases of GEP-NETs are a known major prognostic factor with a strong effect on patients' survival. To date, various treatment options are available, whereas surgery remains the only curative option. Because large liver resections often cannot be performed due to insufficient remnant liver volume, a special operative technique, "cherry picking" (multiple nonanatomic liver resections), can be used as a tissue-preserving procedure.
Methods:
Of 91 patients with various GEP-NETs, 16 patients were identified with synchronous or metachronous multifocal, bilobular liver metastases (>10). All were treated with "cherry picking." Patient records were reviewed retrospectively and clinical data and pathology results were analyzed.
Results:
Mean survival after primary tumour resection was 82.8 versus 41.2 months after liver surgery. All 16 patients are still alive. Mean recurrence-free survival after primary tumour operation was 49.8 versus 24.6 months after liver surgery. Complications of cherry picking included two postoperative biliary leakages and three small hepatic abscesses (conservative/interventional approach 25 % (n = 4), surgical approach 6.25 % (n = 1). There was no postoperative mortality. Initial hormonal symptoms (5/16 patients) completely disappeared postoperatively in 2 patients and were significantly decreased in 3 patients.
Conclusions:
The tissue-preserving surgical technique "cherry picking" has developed due to improved imaging techniques and increased knowledge in liver anatomy, which has helped to make this approach safer and easier. Highly selected patients with multiple bilobular liver metastases of GEP-NET can benefit from this special surgical approach, also applicable for recurrent metastases.
Insights
The "cherry picking" surgical technique offers a tissue-preserving option for liver metastases from gastroenteropancreatic neuroendocrine tumors (GEP-NETs). This approach shows promising survival and recurrence-free survival rates in selected patients with multiple liver lesions.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenteropancreatic Neuroendocrine Tumors (GEP-NETs)
Background:
- Liver metastases from GEP-NETs significantly impact patient survival.
- Surgery is the only curative option for GEP-NET liver metastases.
- Limited remnant liver volume often precludes extensive liver resections.
Purpose of the Study:
- To evaluate the efficacy and safety of the "cherry picking" technique for GEP-NET liver metastases.
- To assess survival and recurrence-free survival outcomes in patients treated with this method.
- To analyze complications associated with the "cherry picking" procedure.
Main Methods:
- Retrospective analysis of 16 patients with GEP-NETs and multiple, bilobular liver metastases (>10).
- All patients underwent the "cherry picking" (multiple nonanatomic liver resections) technique.
- Clinical data and pathology results were reviewed.
Main Results:
- Mean survival post-liver surgery was 41.2 months (vs. 82.8 months post-primary tumor resection).
- All 16 patients remained alive post-liver surgery; mean recurrence-free survival was 24.6 months.
- Complications included biliary leakages and hepatic abscesses; no postoperative mortality was observed.
Conclusions:
- "Cherry picking" is a safe and effective tissue-preserving technique for selected patients with multiple GEP-NET liver metastases.
- Improved imaging and anatomical knowledge enhance the safety and feasibility of this approach.
- This technique is also applicable for recurrent GEP-NET liver metastases.
