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Nichtoperative Ablation

Möglichkeiten und Grenzen der Ablationsverfahren zur Behandlung von Lebermetastasen unter kurativer Intention

Nonoperative ablation for liver metastases

Possibilities and limitations as a curative treatment

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Zusammenfassung

Unter dem Begriff der „nichtoperativen Ablation“ werden eine Reihe heterogener Techniken zur Behandlung von Lebermetastasen zusammengefasst, wie beispielsweise die Radiofrequenztherapie (RF), die laserinduzierte Thermotherapie (LITT) und die Kryotherapie. Bislang galten die Verfahren im Wesentlichen als palliative Therapieoptionen. Wesentliche limitierende Faktoren waren die Induktion klinisch relevanter Läsionsvolumina und das Fehlen von Langzeitstudien. Innerhalb der letzten Jahre werden mit neu entwickelten Applikationssystemen der RF und LITT bemerkenswerte Ergebnisse erzielt, und erste klinische Studien zeigen bei selektierten Patienten vergleichbare Daten mit denen der chirurgischen Resektion. Die vorliegende Arbeit soll eine Übersicht über Möglichkeiten und Grenzen der nichtoperativen Ablation in Bezug auf den Einsatz unter kurativer Intention geben, wobei ein besonderes Gewicht auf die histopathologischen Grundlagen hyperthermer Läsionen sowie den klinischen Ergebnissen in Hinblick auf die „R0-Ablation“ und das Langzeitüberleben gelegt wird.

Abstract

Under the term “nonoperative ablation” are grouped a number of heterogeneous approaches for the treatment of liver metastases, including laser-induced thermotherapy (LITT), radio-frequency therapy (RF), and cryotherapy. In general these procedures had been intended only for palliative purposes. The establishment of clinically relevant lesion size and a lack of long-term survival data were regarded as main limitations to using them with curative intention. During the last years however, new application systems have demonstrated remarkable results in RF and LITT, and some clinical studies have shown long-term survival in selected patients comparable to that for hepatic resection. We review possibilities and limitations of nonoperative ablation procedures with curative intent, highlighting the histopathological bases of thermal ablation techniques and clinical aspects such as R0 ablation and long-term survival.

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Authors and Affiliations

  1. Klinik für Allgemein-, Visceral- und Thoraxchirurgie, Klinikum Nürnberg Nord, Nürnberg

    C.-T. Germer & C. Isbert

  2. Chirurgische Klinik I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin

    H. J. Buhr

  3. Klinik für Allgemein-, Visceral- und Thoraxchirurgie, Klinikum Nürnberg Nord, Prof.-Ernst-Nathan-Straße 1, 90419 , Nürnberg

    C.-T. Germer

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  1. C.-T. Germer
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Correspondence to C.-T. Germer.

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Germer, CT., Buhr, H.J. & Isbert, C. Nichtoperative Ablation. Chirurg 76, 552–563 (2005). https://doi.org/10.1007/s00104-005-1047-5

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