Zusammenfassung
Hintergrund
Kolorektale Lebermetastasen (KLM) mit extensivem, bilobärem Verteilungsmuster bzw. kritischer intrahepatischer Lage benötigen für eine kurative Zielsetzung komplexe chirurgische Resektionstechniken.
Ziel der Arbeit
In der vorliegenden Arbeit beschreiben wir aktuelle Techniken der hepatoonkologischen Chirurgie, mit denen auch bei vermeintlich grenzwertig kleinem gesundem Leberrest eine kurative Resektionsstrategie verfolgt werden kann. Es werden die Methoden der Pfortaderembolisation/-ligatur, der Kombination aus Resektion und Ablation, der zweizeitigen Resektionsstrategie und der „In-situ-split“-Resektion, auch unter „ALPPS“ („associating liver partition and portal vein ligation for staged hepatectomy“) bekannt, diskutiert. Kurz wird auch auf die extrahepatische oligometastasierte Situation eingegangen.
Material und Methoden
Revision aktueller Literatur und Diskussion des an unserer Klinik entwickelten Verfahrens des „in situ split“.
Ergebnisse
In den letzten Jahren wurden die chirurgischen Techniken, kolorektale Metastasen kurativ zu resezieren, signifikant erweitert, wodurch auch bei extensiver Metastasierung kurative Resektionen möglich wurden.
Diskussion
Eingebettet in ein multimodales Therapiekonzept ist es essenziell, dass die Resektabilität kolorektaler Metastasen auch in vermeintlich „aussichtslosen“ Fällen durch einen erfahrenen, hepatobiliären Chirurgen beurteilt wird.
Abstract
Background
Extensive, bilobular and multifocal colorectal liver metastases (CLM) or metastases that are critically situated require an experienced surgeon and advanced surgical techniques to enable curative resection.
Objective
This article describes the toolbox of hepato-oncologic surgery including functional augmentation of liver segments by portal vein embolization/ligation, combinations of ablation and resection, two-stage resections and in situ split liver resection, also known as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Furthermore, the curative resection of extrahepatic, oligometastatic disease are briefly discussed.
Material and methods
Review of current literature as well as discussion of the ALPPS procedure, which was developed at our institute.
Results
In recent years, oncologic resections for CLM have been significantly refined, leading to a constant increase of curative resection rates.
Conclusion
In a multimodality treatment setting, surgical resection of CLM remains the gold standard curative approach and even in the event of presumed hopeless cases with extensive metastasis, experienced hepatobiliary surgeons must evaluate the resectability of colorectal metastases.
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C. Hackl, S. M. Brunner, K. M. Schmidt und H. J. Schlitt geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Hackl, C., Brunner, S.M., Schmidt, K.M. et al. Chirurgische Innovationen in der Therapie des metastasierten kolorektalen Karzinoms. Chirurg 89, 191–196 (2018). https://doi.org/10.1007/s00104-017-0583-0
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DOI: https://doi.org/10.1007/s00104-017-0583-0