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Chirurgische Therapie der benignen Lebertumoren

Surgical therapy of benign liver tumors

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Zusammenfassung

Durch verbesserte Diagnostik und vermehrten Einsatz bildgebender Verfahren werden benigne Lebertumoren immer häufiger diagnostiziert. Bei eindeutiger Diagnose und Fehlen von tumorassoziierten Symptomen besteht beim Hämangiom und der fokal nodulären Hyperplasie (FNH) keine Operationsindikation. Das Leberzelladenom (LZA) sollte bei entsprechender Größe in erster Linie aufgrund der Rupturgefahr reseziert werden. Die verbesserte Diagnostik sowie Fortschritte in der chirurgischen Therapie mit niedriger Komplikationsrate und weitgehend fehlender Mortalität erlauben eine individualisierte Therapie von benignen Lebertumoren, die sich an evidenzbasierten Algorithmen zum Management derartiger Leberläsionen anlehnen sollte. Bei nach wie vor bestehender diagnostischer Unsicherheit und bei Fehlen wesentlicher Risikofaktoren wird der risikoarmen Resektion der Vorzug vor einer Biopsie aufgrund der publizierten Fehlerquote und Komplikationsmöglichkeiten (Blutung, Tumorzellverschleppung) gegeben.

Abstract

Benign liver tumors are being detected more frequently due to the widespread use of ultrasound and complementary methods and due to improvements in diagnostic accuracy. In the case of a reliable diagnosis of asymptomatic hemangioma or focal nodular hyperplasia surgery is not indicated. Hepatic adenoma of considerable size should be resected primarily based on the risk of rupture. Improvements in diagnostic imaging as well as the optimization of surgical procedures with extremely low complication rates permit an individualized management strategy founded on evidence-based algorithms. In the case of an equivocal diagnosis, we advocate low-risk tumor resection instead of tumor biopsy due to the inherent complication rates of hemorrhage or tumor-cell dissemination and possible misleading histology.

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  1. Klinik und Poliklinik für Chirurgie, Klinikum der Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    M. Loss, C. Zülke, A. Obed, O. Stöltzing & H.J. Schlitt

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  1. M. Loss
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  2. C. Zülke
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  3. A. Obed
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  4. O. Stöltzing
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  5. H.J. Schlitt
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Correspondence to M. Loss.

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Loss, M., Zülke, C., Obed, A. et al. Chirurgische Therapie der benignen Lebertumoren. Chirurg 79, 722–728 (2008). https://doi.org/10.1007/s00104-008-1523-9

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  • DOI: https://doi.org/10.1007/s00104-008-1523-9

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