Chirurgie der Leber: Grenzen des Machbaren

Zusammenfassung

Einleitung: Bilobäre Lebermetastasen, ein geringes Restlebervolumen, De-novo- und Rezidivmetastasen, simultane Lungenmetastasen und die Infiltration von Gefäßen sind häufig limitierende Faktoren in der chirurgischen Therapie primärer und sekundärer Lebertumoren. Dennoch ist die Chirurgie der „Gold Standard” mit der Möglichkeit von einem Langzeitüberleben, an das lokalablative Maßnahmen und Chemotherapie nicht herankommen. Methoden: Die Kombination mit neoadjuvanter Chemotherapie und lokalablativen Verfahren, erweiterte Leberresektionen nach selektiver Pfortaderembolisation, zweizeitige Resektionen, die Resektion und Rekonstruktion zentraler Gefäße und simultane oder zweizeitige Resektionen von Lungenmetastasen sind Methoden, die die Resektabilität fortgeschrittener primärer und sekundärer Lebertumoren steigern. 5-Jahres-Überlebensraten von 26-46 % bei kolorektalen Lebermetastasen, 40 % bei primären Lebertumoren und ein mittleres Überleben von 42 Monaten nach Resektion von Leber- und Lungenmetastasen können dadurch erreicht werden. Schlussfolgerung: Ein interdisziplinäres Vorgehen und eine aggressive chirurgische Therapie bei primären und sekundären Lebertumoren bzw. bei proximalen Gallengangskarzinomen ermöglichen gute Langzeitergebnisse bei akzeptabler Morbidität und Mortalität.

Abstract

Background: Bilobar hepatic metastases, a small residual liver volume, de-novo and recurrent lesions, simultaneous pulmonary metastases and infiltration of vascular structures are often limiting factors in the surgical treatment of primary and secondary liver tumors. Nevertheless surgery is the “gold standard” with the chance of long-term survival, not possible to achieve with locally ablation and chemotherapy. Methods: The combination with neoadjuvant chemotherapy and radiofrequency ablation, extended liver resection after selective portal vein embolization, two-stage hepatectomy, resection and reconstruction of vascular structures in deep hypothermia and simultaneous resection of pulmonary metastases, increase the resectability even in patients with poor prognosis achieving 5-year-survival rates between 26-46 % in colorectal liver metastases, 40 % in primary liver tumors and a median survival of 42 months after resection of liver and lung metastases. Conclusion: Interdisciplinary treatment and aggressive surgical resection seem to be justified, when performed safely as a curative option.

neoadjuvante Chemotherapie - lokale Tumorablation - Pfortaderembolisation - zweizeitige Leberresektion - Resektion von Lungenmetastasen

neoadjuvant chemotherapy - locally ablation therapy - portal vein embolization - two-stage hepatectomy - pulmonary resection

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