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Lebermetastasen

Indikation und Ergebnisse der Leberresektion und interventioneller Behandlungsverfahren

Liver metastases

Indication and results of liver resection and interventional therapy

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Die Leberresektion zur Behandlung von Metastasen solider Tumoren mit kurativer Zielsetzung kann heute mit einer akzeptablen perioperativen Morbidität und Letalität (<3%) durchgeführt werden. Die meisten Erfahrungen liegen mit den Metastasen kolorektaler Karzinome vor. Die Fünfjahresüberlebensraten betragen hier bei primärer, aber auch bei wiederholter, Metastasenresektion jeweils 25–30%. Allerdings sind zum Zeitpunkt der Diagnose lediglich knapp 20% der Patienten durch eine Leberresektion potenziell kurvativ behandelbar. Stand bisher die intra- und postoperative Risikominimierung als Voraussetzung für eine gute Langzeitüberlebensrate im Vordergrund, so erscheint eine Prognoseverbesserung künftig in erster Linie durch eine Erweiterung der Indikations- und Therapiespektren möglich. Zwar haben adjuvante Therapiemaßnahmen nach Leberresektion bisher keine Erfolge gezeitigt, doch konnte bei Ansprechen auf eine Induktionstherapie bei ca. 15% der Patienten mit primär nicht resektablen Metastasen sekundär eine vollständige Metastasenresektion mit kurativer Zielsetzung durchgeführt werden. Darüber hinaus ist zu erwarten, dass die Kombination der Leberresektion mit interventionellen Verfahren sowie eine weitere chirurgische Spezialisierung es ermöglichen, bis dato nicht resektable Lebermetastasen operativ anzugehen. Die Kombination resezierender und thermoablativer Verfahren, die selektive portale Embolisation, mehrzeitige Leberresektionen und die Möglichkeiten multimodaler Therapiekonzepte bei primär nicht kurativ operablen Befunden müssen künftig in klinischen Studien systematisch überprüft werden.

Abstract

Liver resection for metastatic disease can be performed with curative intent at low operative mortality (<3%). To date, most experience relates to colorectal liver metastases. Five-year survival following primary and repeat liver resection has consistently been reported to be 25–30%. Although adjuvant chemotherapy following liver resection has been ineffective, induction chemotherapy results in secondary resectability of liver metastases in a substantial number of patients.

Future strategies should, therefore, aim to increase the number of patients amenable to potentially curative liver resection. This could be achieved by earlier diagnosis, by combination of liver resection with induction chemotherapy or thermoablation and selective portal vein embolization as well as further surgical specialization. All these novel approaches require systematic testing preferably by randomized trials.

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  1. Abt. für Allgemein- und Gefäßchirurgie, Chirurgische Universitätsklinik Frankfurt/Main

    M. Golling & S. Pepperl

  2. Kliniken für Allgemeine, Viscerale und Gefäßchirurgie, Klinikum Bremen Mitte

    T. Lehnert

  3. Kliniken für Allgemeine, Viscerale und Gefäßchirurgie, Klinikum Bremen Mitte, Sankt-Jürgen-Straße 1, 28205 , Bremen

    T. Lehnert

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Golling, M., Pepperl, S. & Lehnert, T. Lebermetastasen. Onkologe 10, 474–491 (2004). https://doi.org/10.1007/s00761-004-0707-2

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