Summary
Background: Primary liver tumors or liver metastases may be either irresectable, or only resectable at high risk because of their local relation to important vascular structures (hilum of liver, venous confluens, V. cava).
Methods: Technically advanced methods of liver resection based on hypothermic perfusion are described, analyzed, and discussed.
Results: The techniques of ex-situ, ante-situm, or in-situ liver surgery under hypothermic perfusion permit resection under complete vascular occlusion without considerable time limitations, and with optimized exposition. If required, extended vascular reconstructions may be performed. The results, however, show that these techniques of resection are associated with a relevant morbidity and mortality, although radical resection can be achieved in many instances. Good results can be obtained with increasing experience and optimized indications in selected cases.
Conclusions: These advanced approaches to liver resection have enriched the surgical armament and can be useful in defined situations.
Zusammenfassung
Grundlagen: Primäre Lebertumoren oder Lebermetastasen können aufgrund ihrer Lagebeziehung zu kritischen Gefäßstrukturen (Leberhilus, venöser Konfluens oder V. cava) nicht oder nur mit hohem operativem Risiko resezierbar sein.
Methodik: Technisch fortgeschrittene Methoden der Leberresektion unter hypothermer Perfusion werden vorgestellt, analysiert und diskutiert.
Ergebnisse: Die Techniken der Leberresektion unter hypothermer Perfusion ex situ, ante situm oder in situ erlauben eine Resektion unter komplett ischämischen Bedingungen, ohne relevante Zeitlimitierung und mit optimaler Exposition. Falls erforderlich, können auch komplexe Gefäßrekonstruktionen durchgeführt werden. Die Ergebnisse zeigen, daß diese Verfahren der Resektion mit einer relevanten Morbidität und Mortalität verbunden sind, in vielen Fällen jedoch eine radikale Resektion erreicht werden kann. Mit zunehmender Erfahrung und optimierter Indikationsstellung können in ausgewählten Fällen gute Ergebnisse erzielt werden.
Schlußfolgerungen: Insgesamt erweitern diese fortgeschrittenen Verfahren der Leberresektion das Rüstzeug des Chirurgen und können bei bestimmten Indikationen sinnvoll sein.
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Schlitt, H.J., Oldhafer, K.J., Bornscheuer, A. et al. In-situ, ante-situm, and ex-situ surgical approaches for otherwise irresectable hepatic tumors. Acta Chir Austriaca 30, 215–219 (1998). https://doi.org/10.1007/BF02620208
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DOI: https://doi.org/10.1007/BF02620208