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Liver resection and transplantation — Therapeutic concepts in surgical treatment of hepatic metastases

Leberresektion und Lebertransplantation — Therapeutische Konzepte zur chirurgischen Therapie von Lebermetastasen

  • Main Topics: Liver Resection Or Transplantation — New Therapeutic Concepts
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: Surgical procedures such as liver resection or liver transplantation are the only treatment modalities that provide a chance of cure for patients with liver metastases.

Methods: This report reviews results of liver resection and liver transplantation for liver metastases from colorectal cancer and neuroendocrine tumors as compared to the natural course.

Results: Overall 5 year survival after curative liver resection for colorectal metastases ranges between 25 and 48%. The operative mortality is between 0 and 5%. Risk factors for tumor recurrence are more or less defined. Reresections of metastases can be performed with comparable mortality rates and results. Liver transplantation for unresectable colorectal metastases offers a median survival of 28 months, but the chance of cure only for individual patients. Exclusion of patients with positive lymph nodes of the primary tumor improves median survival. As there are alternative treatment options for neuroendocrine metastases, indication for liver resection or transplantation is not clearly defined, but the chance of cure by means of surgical treatment should not be missed. Curative resections of neuroendocrine liver metastases can achieve 5-year survival rates of more than 80%.

Conclusions: Radical surgical removal of liver metastases from colorectal and neuroendocrine cancer can improve the prognosis for selected patients. Further improval is expected from a multimodal approach.

Zusammenfassung

Grundlagen: Chirurgische Verfahren wie die Leberresektion oder die Lebertransplantation sind die einzigen therapeutischen Möglichkeiten, die dem Patienten eine Chance auf Heilung von Lebermetastasen bieten.

Methodik: In dieser Arbeit stellen wir die Ergebnisse der Leberresektion und der Lebertransplantation in der Behandlung von Lebermetastasen kolorektaler und neuroendokriner Metastasen vor und vergleichen diese mit dem Spontanverlauf der unbehandelten Erkrankung.

Ergebnisse: Das 5-Jahres-Überleben nach kurativer Leberresektion wegen kolorektaler Lebermetastasen bewegt sich zwischen 25 und 48%. Die operative Mortalität liegt zwischen 0 und 5%. Risikofaktoren für das Wiederauftreten des Tumors sind bekannt. Eine neuerliche Resektion ist in Einzelfällen möglich, operative Mortalität und Ergebnisse liegen im Bereich der Ersteingriffe. Nach Lebertransplantation wegen nicht resezierbarer kolorektaler Metastasen beträgt das mediane Überleben 28 Monate, Heilung wurde nur in Einzelfällen beobachtet. Der Ausschluß von Patienten mit positiven Lymphknoten im Primärtumor konnte das mediane Überleben verlängern. Da es zur Behandlung von Lebermetastasen neuroendokriner Tumoren wirksame alternative Behandlungsmethoden gibt, ist die Indikation zur Leberresektion oder Lebertransplantation nicht klar definiert. Bei einer chirurgischen Möglichkeit auf Heilung sollte diese jedoch genützt werden. Mit kurativer Resektion von neuroendokrinen Lebermetastasen ist ein 5-Jahres-Überleben von >80% möglich.

Schlußfolgerungen: Die chirurgisch radikale Entfernung von Lebermetastasen kolorektaler und neuroendokriner Tumoren kann die Prognose von ausgewählten Patienten verbessern. Eine weitere Verbesserung wird von einem multimodalen Therapieansatz erwartet.

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  1. Division of Transplantation Surgery, Department of Surgery, University of Vienna, Währingergürtel 18-20, A-1090, Vienna

    R. Steininger M.D. & T. Grünberger

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  1. R. Steininger M.D.
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Steininger, R., Grünberger, T. Liver resection and transplantation — Therapeutic concepts in surgical treatment of hepatic metastases. Acta Chir Austriaca 30, 206–210 (1998). https://doi.org/10.1007/BF02620205

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  • DOI: https://doi.org/10.1007/BF02620205

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