Chirurgische Therapie kolorektaler Lebermetastasen: Möglichkeiten und Grenzen

Zusammenfassung

Lebermetastasen treten bei 40 % der Patienten mit kolorektalen Karzinomen auf. Die Verbesserung der chirurgischen Techniken und des perioperativen Managements haben zu einer deutlichen Senkung der Morbidität und Mortalität der Lebermetastasenresektion (LMR) geführt. Vor dem Hintergrund eines zunehmenden Verständnisses der Tumorbiologie einerseits und deutlich verbesserter Überlebensraten andererseits ist in den letzten Jahren die Indikationsstellung zur LMR in spezialisierten Zentren erweitert worden. Die Therapiestrategie verlagerte sich dabei von einer resektionstechnisch standardisierten Intervention zu einem individualisierten, interdisziplinär geplanten Behandlungskonzept, das sowohl eine präoperative Chemotherapie, mehrzeitige Leberresektionen als auch die ausgedehnte Resektion extrahepatischer Tumormanifestationen umfasst. Ziel dieser Arbeit ist es, den gegenwärtigen Stellenwert der LMR im interdisziplinären Behandlungskonzept darzustellen. Dabei werden insbesondere Grenzsituationen betrachtet, in denen in der Vergangenheit ausschließlich palliative Chemotherapien als einzig sinnvolle onkologische Therapieoption angesehen wurden.

Abstract

40 % of patients suffering from colorectal cancer will develop liver metastases during the course of their disease. Advances in both surgical technique and perioperative management lead to a decrease in postoperative morbidity and mortality. Against the background of an increasing understanding of tumor biology as well as excellent survival data following hepatic resection, the indication for liver resection has been extended in specialized surgical centers. Similarly the intention to treat changed from a standardized resection towards an individual and interdisciplinary therapy including preoperative chemotherapy, staged liver resection and resection of extrahepatic disease. The aim of this study is to investigate the current value of hepatic resection for colorectal liver metastases in the interdisciplinary oncological concept. It specially addresses these challenging situations where palliative chemotherapy seemed to be the only reasonable way of therapy in past.

kolorektale Lebermetastasen - Pfortaderligatur - wiederholte Leberresektion - extrahepatische Tumormanifestation - Resektionsrand

colorectal liver metastases - portal vein ligation - recurrent liver resection - extrahepatic disease - resection margin

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