Zusammenfassung
Hintergrund
Die bildgebende Diagnostik ist für den Leberchirurgen ein wichtiger Baustein in der präoperativen Planung bzgl. Ausmaß und potenzieller Schwierigkeiten während einer Leberoperation.
Methoden
Wesentlich für den Therapieplan eines Patienten sind Anamnese, klinischer Befund und das erste radiologische Bild; keineswegs reicht ein schriftlicher Befund allein.
Ergebnisse
Durch die ständig verbesserte Diagnostik von Leberpathologien kann in zunehmendem Maße dem Patienten ein „wenn und aber, vielleicht und werden wir sehen“ erspart und eine sinnvolle präoperative Auslotung der therapeutischen Optionen erklärt werden.
Diskussion
Eine Besprechung in einem interdisziplinären Forum sollte im Zeitalter der Spezialisierung zentraler Bestandteil in der Diagnostik und in der daraus resultierenden Therapie von Patienten mit hepatobiliären Erkrankungen sein. Ist ein solches Forum im individuellen Fall nicht vorhanden, sollte die Einholung einer Expertenmeinung die Grundlage für weitere Therapieentscheidungen darstellen.
Abstract
Background and purpose
Radiology is an essential preoperative tool for a liver surgeon to plan extent of resection and potential difficulties during liver surgery.
Material and Methods
Primary goal in defining liver pathologies is a careful patients’ history, a clinical evaluation and reviewing at least one radiological film one could acquire. Don’t rely on written reports that may direct you in a useless track. This overview tries to address the essential radiological requests of a surgeon in defining liver tumors ethiology and best optional treatment.
Results
Major advances in radiologic diagnostics led to an improvement in the adequate staging of a given liver pathology. Therefore we are nowadays able to inform our patients about possible treatment options without leaving a big gap to possible intra-operative findings which may alter the therapy. Surgical exploration to define therapeutic strategies becomes fundamental only in a minority of patients with unclear preoperative imaging studies.
Discussion
Interdisciplinary groups should define future strategies in a patient with a given liver pathology. Specialisation has defined the hepatobiliary surgeon which should be consulted in case of a liver or biliary tumor to guide possible therapeutic treatment options.
Literatur
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318; discussion 318–321
Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, Takayama T, Makuuchi M (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206
Junginger T (2002) Local treatment of liver metastases—multidisciplinary polypragmasia or interdisciplinary strategy? Zentralbl Chir 127:255–256
Jaeck D, Bachellier P, Weber J, Oussoultzoglou E, Greget M (2003) Process in surgical exeresis of colorectal cancer liver metastases. Bull Acad Natl Med 187:863–869
Schima W, Ba-Ssalamah A (1999) Radiologic staging of liver and pancreatic malignancies. Radiologe 39:568–577
Sojar V, Stanisavljevic D, Hribernik M, Fius T, Kreuh D, Velkavrh U (2004) Liver surgery planning in 3D virtual space. HPB 6 [suppl 1]:179
Lerner S, Hiatt J, Salamandra J, Chen P, Farmer D, Ghobrial R, Busuttil R (2004) Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg 139:818–821
Hussain SM, Terkivatan T, Zondervan PE, Lanjouw E, de Rave S, Ijzermans JNM, de Man RA (2004) Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. RadioGraphics 24:3–17
Chiche L, Dao T, Salame E, Galais MP, Bouvard N, Schmutz G, Rousselot P, Bioulac-Sage P, Segol P, Gignoux M (2000) Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature. Ann Surg 231:74–81
Okuda K (2002) Natural history of hepatocellular carcinoma including fibrolamellar and hepato-cholangiocarcinoma variants. J Gastroenterol Hepatol 17:401–405
El-Serag H, Davila J (2004) Is fibrolamellar carcinoma different from hepatocellular carcinoma? A US population-based study. Hepatology 39:798–803
Belghiti J, Cortes A, Abdalla E, Regimbeau J, Prakash K, Durand F, Sommacale D, Dondero F, Lesurtel M, Sauvanet A, Farges O, Kianmanesh R (2003) Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 238:885–893
Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, Nakanuma Y, Okita K, Omata M, Takayasu K, Yamaoka Y (2004) Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer 101:796–802
Llovet J, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442
Patel T (2001) Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 33:1353–1357
Puhalla H, Schuell B, Pokorny H, Kornek G, Scheithauer W, Gruenberger T (2004) Treatment and outcome of intrahepatic cholangiocellular carcinoma. Am J Surg (accepted)
Gruenberger T, Schuell B, Puhalla H, Schwanzer E, Bodingbauer M, Laengle, F, Kornek G, Scheithauer W (2004) Changes in liver surgery for colorectal cancer liver metastases under neoadjuvant treatment strategies. Eur Surg (in press)
Gruenberger T (2002) Alternative regional treatment of resectable and unresectable liver metastases. Eur Surg 34:337–340
Braga L, Guller U, Semelka R (2004) Modern hepatic imaging. Surg Clin North Am 84:375–400
Sahani DV, Kalva SP, Tanabe KK, Hayat SM, O’Neill MJ, Halpern EF, Saini S, Mueller PR (2004) Intraoperative US in patients undergoing surgery for liver neoplasms: comparison with MR imaging. Radiology 232:810–814
Koea JB, Broadhurst GW, Rodgers MS, McCall JL (2003) Inflammatory pseudotumor of the liver: demographics, diagnosis, and the case for nonoperative management. J Am Coll Surg 196:226–235
Knoefel WT, Prenzel KL, Peiper M, Hosch SB, Gundlach M, Eisenberger CF, Strate T, Scheunemann P, Rogiers X, Izbicki JR (2003) Klatskin tumors and Klatskin mimicking lesions of the biliary tree. Eur J Surg Oncol 29:658–661
Kokudo N, Makuuchi M, Natori T, Sakamoto Y, Yamamoto J, Seki M, Noie T, Sugawara Y, Imamura H, Asahara S, Ikari T (2003) Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 138:741–750
Kim J, Kim T, Eun H, Kim B, Lee M, Kim P, Ha H (2002) Preoperative evaluation of gallbladder carcinoma: efficacy of combined use of MR imaging, MR cholangiography, and contrast-enhanced dual-phase three-dimensional MR angiography. J Magn Reson Imaging 16:676–684
Interessenkonflikt:
Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gruenberger, T. Anforderungen der Chirurgie an die bildgebende Diagnostik. Radiologe 44, 1154–1159 (2004). https://doi.org/10.1007/s00117-004-1137-2
Issue Date:
DOI: https://doi.org/10.1007/s00117-004-1137-2