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Die Rolle der Viszeralchirurgie bei Oligometastasierung nichtgastrointestinaler Tumoren

Role of visceral surgery in oligometastases of non-gastrointestinal tumors

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Zusammenfassung

Hintergrund

Bei Oligometastasierung können Patienten von einer lokalen Therapie der Metastasen profitieren. Unter dieser Prämisse wird die Resektion von Lebermetastasen und viszeralen Metastasen nichtgastrointestinaler Tumoren bei selektionierten Patienten zunehmend durchgeführt. Ziel der Arbeit ist es, die Rolle der Viszeralchirurgie bei hepatischer Oligometastasierung nichtgastrointestinaler Tumoren anhand der aktuellen Datenlage zu erörtern.

Material und Methoden

Medline- und PubMed-Recherche zum Thema Oligometastasierung, Leberresektion und Metastektomie beim Mamma-Karzinom (CA), Nierenzell-CA, malignen Melanom, Ovarial-CA und „non-small cell lung cancer“ (NSCLC).

Ergebnisse

Die Evidenz beschränkt sich auf retrospektive Studien und Fallserien. Bei selektionierten Patienten können unter multimodaler Therapie 5‑Jahres-Überlebensraten von bis zu 53 % (Mamma-CA), 62 % (Nierenzell-CA), 22 % (malignes Melanom) und 50 % (Ovarial-CA) sowie beim hepatisch metastasierten NSCLC ein medianes Überleben von 12 Monaten erreicht werden. Prognostische Faktoren und Selektionskriterien hinsichtlich einer Leberresektion sind ein krankheitsfreies Intervall von >12 Monaten, das Erreichen einer R0-Situation, das Ansprechen auf eine systemische Therapie sowie das Vorliegen extrahepatischer/extraabdomineller Metastasen. Rezidivleber‑, Pankreasresektionen und zytoreduktive Chirurgie mit multiviszeraler Resektion (Ovarial-CA) können ebenso prognostisch günstig sein.

Schlussfolgerung

Trotz eingeschränkter Evidenz scheint die Leberresektion im Stadium der Oligometastasierung bei nichtgastrointestinalen Tumoren eine Prognoseverbesserung erreichen zu können. Die Tumorbiologie und das Ansprechen auf zielgerichtete personalisierte systemische Therapien gewinnen hierbei an Bedeutung.

Abstract

Background

Patients with oligometastatic disease can benefit from local treatment of the metastases. Under these premises the resection of liver metastases and visceral metastases of non-gastrointestinal tumors is performed increasingly more frequently in selected patients. The aim of this study was to evaluate the role of visceral oncological surgery in hepatic oligometastatic disease of non-gastrointestinal tumors according to the currently available literature.

Material and methods

A systematic search of MEDLINE and PubMed was carried out focusing on the topics of oligometastases, liver resection and metastectomy for breast cancer, renal cell carcinoma, malignant melanoma, ovarian cancer and non-small cell lung cancer.

Results

The evidence is limited to retrospective studies and case series. In selected patients after liver resection and multimodal therapy 5‑year survival rates of 53% (breast cancer), 62% (renal cell carcinoma), 22% (malignant melanoma) and 50% (ovarian cancer) are described. For lung cancer (NSCLC) median survival was 12 month. Prognostic factors n were a disease free survival of >12 months, R0-resection, response to systemic therapy and extra hepatic/extra abdominal metastases. These could be selection criteria for liver resection. Recurrence liver resection, resection of the pancreas and cytoreductive surgery including multivisceral resection (ovarian cancer) could also improve survival.

Conclusion

Regarding limited evidence patients with oligometastatic disease origin from non-gastrointestinal tumors could benefit from liver resection. Tumor biology and response to targeted individualized systemic therapy become more important in this scenario.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    R. Wahba FEBS, D. Stippel & C. Bruns

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  1. R. Wahba FEBS
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  3. C. Bruns
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Correspondence to R. Wahba FEBS.

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R. Wahba, D. Stippel und C. Bruns geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wahba, R., Stippel, D. & Bruns, C. Die Rolle der Viszeralchirurgie bei Oligometastasierung nichtgastrointestinaler Tumoren. Chirurg 89, 523–528 (2018). https://doi.org/10.1007/s00104-018-0647-9

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