“Cherry Picking”, a Multiple Non-anatomic Liver Resection Technique, as a Promising Option for Diffuse Liver Metastases in Patients with Neuroendocrine Tumours

• Published in: World journal of surgery 2014-02, Vol.38 (2), p.392-401
• Main Authors: Krausch, Markus, Raffel, Andreas, Anlauf, Martin, Schott, Matthias, Lehwald, Nadja, Krieg, Andreas, Topp, Stefan Andreas, Cupisti, Kenko, Knoefel, Wolfram Trudo
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Cardiac Surgery; Gastrointestinal Neoplasms - pathology; General Surgery; Hepatectomy - methods; Humans; Kaplan-Meier Estimate; Liver Metastasis; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver Resection; Medicine; Medicine & Public Health; Middle Aged; Neuroendocrine Tumors - surgery; Pancreatic Neoplasms - pathology; Peptid Receptor Radionuclide Therapy; Primary Tumour Resection; Retrospective Studies; Surgery; Tace; Thoracic Surgery; Tomography, X-Ray Computed; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-2267-3

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.