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Chirurgische Therapie von Lebermetastasen

Surgical therapy of liver metastases

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Obwohl Fernmetastasen Ausdruck einer Systemerkrankung sind, gewinnen lokale Verfahren in der Therapie von Lebermetastasen zunehmend an Bedeutung.

Ziel

Die Ergebnisse der Resektion von Lebermetastasen maligner Erkrankungen werden dargestellt.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed.

Ergebnisse

Durch die Reduktion der perioperativen Mortalität und die Entwicklung mehrzeitiger Resektionsverfahren kann auch eine ausgedehnte und rezidivierende Metastasierung sicher reseziert werden. In die Indikationsstellung zur Leberresektion müssen neben der technischen und funktionellen Machbarkeit immer die zu erwartende Morbidität sowie der vermeintliche onkologische Benefit einfließen. Die onkologische Resektabilität (Benefit) kann durch verschiedene Scores bereits präoperativ abgeschätzt werden. Diese Abwägung sollte in einem Tumorboard mit entsprechender (leberchirurgischer) Expertise vorgenommen werden. Sowohl bei kolorektalen als auch bei nichtkolorektalen Lebermetastasen werden 5-Jahres-Überlebensraten von über 60 % erzielt, wobei die Evidenzlage für die Resektion von Metastasen nichtkolorektaler Tumoren noch schwach ist. Dabei weisen Patienten über 75 Jahren vergleichbare Langzeitergebnisse bei nur gering erhöhter perioperativer Mortalität auf. Aktuell sollte die Mortalität von Leberresektionen bei Metastasen unter 1 % liegen. Für die Therapie neuroendokriner Metastasen ist die Datenlage sehr knapp. Während die Kriterien der technischen Resektabilität denen bei nicht neuroendokrinen Metastasen entsprechen, erscheinen Leberresektionen hier v. a. bei geringer Proliferationsrate (Ki67 < 20 %) oder konservativ nicht kontrollierbarer Symptomatik sinnvoll.

Diskussion

Die vorliegenden Daten rechtfertigen den zunehmenden Einsatz der Leberresektion bei sowohl kolorektalen als auch nichtkolorektalen Lebermetastasen.

Abstract

Background

Although distant metastases are signs of systemic disease, local therapies are increasingly used for liver metastasis.

Objective

To analyze current indications and results of surgery for liver metastases of various malignant diseases.

Material and methods

This analysis is based on a selective PubMed literature search.

Results

Due to a decrease in the perioperative mortality and the development of multi-step procedures even extensive and recurrent liver metastasis can be safely resected. As a rule the oncological resectability and expected morbidity of the procedure have to be balanced against the technical feasibility for the indications of liver surgery. Risk scores help in the preoperative assessment of the oncological resectability (expected benefit) for colorectal and non-colorectal metastases. This assessment should be done by an interdisciplinary tumor board with the appropriate (liver surgery) expertise. With careful patient selection 5-year survival rates above 60 % can be achieved for both colorectal and non-colorectal liver metastases although the evidence for non-colorectal liver metastases is weak. Comparable long-term survival has been reported for patients over 75 years old with colorectal metastases. In general the mortality of liver resections for metastasis is below 1 % and only slightly higher in older (> 75 years) patients. In contrast, data on liver resections for neuroendocrine tumors are scarce. The general assessment of the technical resectability does not differ from other indications but liver resections for neuroendocrine metastases should be performed below a proliferative index (Ki67) of 20 % or for otherwise conservatively uncontrollable endocrine symptoms.

Conclusions

The current literature supports the increasing use of surgery for liver metastases of colorectal and non-colorectal cancer.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Heinrich und H. Lang geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 , Mainz, Deutschland

    S. Heinrich &  H. Lang

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  1. S. Heinrich
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  2. H. Lang
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Correspondence to H. Lang.

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Heinrich, S., Lang, H. Chirurgische Therapie von Lebermetastasen. Onkologe 20, 733–739 (2014). https://doi.org/10.1007/s00761-014-2731-1

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  • DOI: https://doi.org/10.1007/s00761-014-2731-1

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