Zusammenfassung
Der zunehmende Einsatz von Ultraschalluntersuchungen in der alltäglichen Praxis führt zu einer kontinuierlich steigenden Zahl der Diagnosen von inzidentellen Lebertumoren. Die korrekte Diagnose des Leber-Inzidentaloms lässt sich in über 90% mit nichtinvasiven Methoden stellen. Eine kritische Indikationsstellung muss insbesondere bei fraglich symptomatischen Inzidentalomen erfolgen. Die „absolute“ Forderung nach operativer Resektion beim Verdacht auf ein Leberzelladenom muss nach neuester Literatur kritisch hinterfragt werden. Der nicht auszuräumende Verdacht auf Malignität stellt vor dem Hintergrund einer geringen Morbidität und weitgehend fehlender Mortalität beim chirurgischen Eingriff eine eindeutige Indikation zur Resektion dar, perkutane Biopsien sind aus onkologischen Überlegungen, oftmals fehlendem diagnostischen Nutzen und Komplikationsgefahr in vielen Fällen nicht sinnvoll.
Die stadiengerechte radikale Reoperation beim Inzidentalom der Gallenblase vermag, mit Erreichen einer R0-Situation, das Langzeitüberleben in den weniger fortgeschrittenen Tumorstadien T1b und dem am häufigsten vorkommenden Stadium T2 signifikant zu verlängern. Patienten mit erhöhtem Risiko für das Vorliegen eines inzidentellen Gallenblasenkarzinoms sollten umfassend über die potentiellen Risiken der laparoskopischen Cholezystektomie aufgeklärt werden. Multimodale Therapiekonzepte zur Behandlung der fortgeschrittenen Tumorstadien sollten im Rahmen von prospektiven Multizentrumstudien evaluiert werden.
Abstract
The expanding use of ultrasound in general practice is leading to an ever increasing rate of detection of true hepatic incidentaloma. The correct diagnosis of hepatic incidentaloma may be made in over 90% with non-invasive means. The questionable diagnosis of “symptomatic” incidentaloma should undergo close scrutiny prior to a decision in favour of surgery. With regard to more recent literature, the former “absolute” requirement for surgical resection in all cases of liver cell adenoma may have to be reappraised. Final inability to rule out malignancy represents an unquestionable indication for surgery in the light of low rates of morbidity and lack of mortality in this otherwise healthy patient group. Percutaneous biopsies should not be performed due to oncological hazards, indeterminate results and potential for acute complications.
The stage-oriented radical re-resection following diagnosis of an incidentally detected gallbladder cancer may lead to significantly improved long-term survival, especially in the early tumour stages T1b and T2, which represents the most common stage of gallbladder cancer in incidentaloma. Patients at elevated risk for incidental gallbladder cancer should undergo thorough instruction with regard to the potential hazards of laparoscopic cholecystectomy. Multimodal therapeutic strategies directed at advanced stages of incidentally detected gallbladder cancer should be evaluated in prospective multicentre studies.
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Zülke, C., Schlitt, H. Inzidentalome der Leber und der Gallenblase. Chirurg 78, 698–712 (2007). https://doi.org/10.1007/s00104-007-1388-3
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DOI: https://doi.org/10.1007/s00104-007-1388-3