Zusammenfassung
Die ökonomische Analyse der Resektion kolorektaler Lebermetastasen ergibt zum Einen,
dass Nachsorgeprogramme in ihrer Effektivität unterschiedlich und ökonomisch häufig
fragwürdig sind. Wird eine Lebermetastase gleichzeitig mit einem Rektumkarzinom entdeckt,
so empfiehlt sich in der Mehrzahl der Fälle ein zweizeitiges Vorgehen, zunächst die
primäre Tumorresektion und dann in einem Folgeschritt die Metastasenresektion. Dies
hat sowohl für den Patienten Vorteile und kommt auch dem Krankenhaus unter ökonomischen
Gesichtspunkten (DRG-Abrechnung) entgegen. Das Zeitintervall zwischen Primärtumor-
und Metastasenresektion verschlechtert die Prognose nicht, im Gegenteil, es werden
so unnötige Resektionen vermieden, falls im Intervall zahlreiche weitere Metastasen
auftreten (Selektionsmechanismus), die eine kurative Resektion ausschließen. Diese
Aussage gilt nicht in gleicher Weise für das Kolonkarzinom: falls die Lebermetastase
leicht zugängig ist, wird hier das Operationsrisiko durch den Simultaneingriff nicht
wesentlich erhöht, der demnach in diesen Situationen empfohlen wird. Weist ein Patient
mehrere Lebermetastasen auf, so zeigt die ökonomische Analyse, dass sowohl die Leberresektion
als auch die palliative Behandlung mit Radiofrequenzablation bzw. einer Kombination
von Leberresektion und Radiofrequenzablation vertretbar sind. Ökonomisch ist die alleinige
Radiofrequenzablation das günstigste palliative Verfahren, ob diese Methode jedoch
einer alleinigen Chemotherapie in der Palliativsituation tatsächlich überlegen ist,
bleibt prospektiven Studien vorbehalten.
Abstract
The economic analysis of surgery in colorectal liver metastases reveals the different
effectiveness of various follow-up programmes after curative surgery for colorectal
cancer. Interval hepatic resection for synchronous liver metastases is recommended
in the majority of cases with rectal cancer. This procedure provides benefits for
the patient and the hospital under the economic point of view. The interval between
primary tumor resection and surgery of liver metastases does not deteriorate the prognosis,
on the contrary, unnecessary resections will be avoided if additional metastases will
grow in the time between, excluding curative treatment (selection mechanism). The
identical statement cannot be applied to patients with colon cancer, since the operative
risk is only slightly increased in case of easily accessible liver metastases which
may be removed simultaneously. However, also in these patients interval hepatic resection
after neoadjuvant chemotherapy should be considered as a therapeutic option! In patients
with multiple liver metastases liver surgery as well as radiofrequency ablation or
a combination of both may be economically justified. Radiofrequency ablation is the
preferred palliative procedure under aspects of cost-effectiveness, however, wether
this procedure is superior to chemotherapy alone has not be evaluated so far in prospectively
randomized trials.
Schlüsselwörter
Kolorektales Karzinom - Lebermetastase - DRG-System - einzeitige Resektion - zweizeitige
Resektion
Key words
colorectal carcinoma - liver metastases - DRG-system - synchronous resection - interval
resection
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Prof. Dr. R. T. Grundmann
Kreiskliniken Altötting · Burghausen
Krankenhausstraße 1
84489 Burghausen
Phone: 0 86 77/88 05 01
Fax: 0 86 77/88 05 03