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Minimalinvasive Chirurgie primärer und sekundärer Lebertumoren

Patientenselektion, Verfahrenswahl, Ergebnisse

Minimally invasive surgery of primary and secondary liver tumors

Indications, techniques and results

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Zusammenfassung

Hintergrund

Initial wurden vornehmlich kleine oberflächliche Leberläsionen laparoskopisch reseziert. Mittlerweile werden in Zentren auch Majorleberresektionen minimalinvasiv durchgeführt. Die Selektion der geeigneten Patienten spielt für die Machbarkeit und den Erfolg des Eingriffs eine zentrale Rolle.

Ziele und Methoden

Diese Arbeit legt die Patientenselektion, Verfahrenswahl und Ergebnisse bei laparoskopischen Leberresektionen auf Basis eines Reviews der aktuellen Literatur dar.

Ergebnisse

Die laparoskopische Leberresektion bietet gegenüber der offenen Resektion deutliche Vorteile hinsichtlich eines reduzierten Blutverlusts, einer verminderten leberspezifischen und Gesamtkomplikationsrate sowie der geringeren Dauer des Krankenhausaufenthalts, ohne die onkologischen Ergebnisse negativ zu beeinflussen.

Schlussfolgerung

Als gut laparoskopisch erreichbar gelten Läsionen in den peripheren Abschnitten der anterolateralen Lebersegmente (Segmente 2, 3, 4b, 5 und 6). Die posterosuperioren Abschnitte (Segmente 1, 4a, 7 und 8) galten zunächst als bedingt geeignet für laparoskopische Resektionen. Jedoch zeigt sich zunehmend, dass auch hier in erfahrenen Zentren sicher und onkologisch radikal minimalinvasiv reseziert werden kann.

Abstract

Background

Initially, mainly superficial liver lesions were resected laparoscopically but now even major resections are performed using a minimally invasive procedure. Careful selection of suitable patients is of key importance.

Aims and methods

This article describes the current state of the art in patient selection and choice of the appropriate laparoscopic technique based on a review of the recent literature. Perioperative and oncological outcome parameters of laparoscopic liver resection are presented.

Results

Laparoscopic liver resection offers significant benefits compared to open liver resection in terms of reduced intraoperative blood loss, reduced overall and liver-specific complications and length of hospital stay without compromising oncological outcomes.

Conclusion

Lesions in the peripheral anterolateral segments (segments 2, 3, 4b, 5 and 6) are particularly suitable for laparoscopic liver resection. Access to the posterosuperior segments 1, 4a, 7 and 8 is more challenging but safe and feasible in experienced centers.

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Einhaltun ethischer Richtlinien

Interessenkonflikt. J. Kirchberg und J. Weitz geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    J. Kirchberg & J. Weitz

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Correspondence to J. Kirchberg.

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Kirchberg, J., Weitz, J. Minimalinvasive Chirurgie primärer und sekundärer Lebertumoren. Chirurg 85, 689–695 (2014). https://doi.org/10.1007/s00104-014-2756-4

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