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Zentralbl Chir 2006; 131(2): 140-147
DOI: 10.1055/s-2006-921538
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© Georg Thieme Verlag Stuttgart · New York

Lebermetastasen kolorektaler Karzinome - Neoadjuvante Konzepte zum präoperativen Downstaging

Colorectal Cancer Liver Metastases - Neoadjuvant Concepts for Preoperative DownsizingM. Golling1 , C. Gog1 , G. Woeste1 , C. Zapletal1 , C. Wullstein1 , W. O. Bechstein1
  • 1Klinik für Allgemein- und Gefäßchirurgie, Chirurgischen Universitätsklinik der Johann Wolfgang Goethe-Universität, Frankfurt/Main
Diese Arbeit widmen wir Prof. Dr. Matthias Lorenz [†], dem ehemaligen leitenden Oberarzt der Klinik und langjährigem Leiter der Arbeitsgemeinschaft Lebermetastasen [ALM].
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Publication Date:
13 April 2006 (online)

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Zusammenfassung

Die Leberresektion zur Behandlung kolorektaler Metastasen unter kurativer Zielsetzung kann heute mit einer geringen perioperativen Morbidität und Letalität durchgeführt werden. Gegenwärtig sind zum Zeitpunkt der Diagnose lediglich knapp 15-30 % der Patienten durch eine Leberresektion kurativ behandelbar. Die 5-Jahres-Überlebensraten bei Lebermetastasen betragen hier bei primärer, aber auch bei wiederholter Metastasenresektion jeweils 25-40 %. Eine Prognoseverbesserung erscheint künftig in erster Linie durch eine Erweiterung des Indikations- und Therapiespektrums möglich. Ziel neoadjuvanter Verfahren ist die Konversion zur sekundären Resektabilität entweder durch Vergrößerung des residualen Leberanteils (Pfortaderembolisation/zweizeitige Hepatektomie) oder einer Reduktion der Tumorlast durch Chemotherapie („downsizing”). Die Studienlage demonstriert unter neoadjuvanter Chemotherapie eine sekundäre Resektabilität bei ca. 8 % der behandelten Metastasen bei einer allerdings erheblichen Varianz zwischen 1 und 33 %.

Abstract

Liver resection for colorectal metastases disease can be performed with curative intent at low morbidity and mortality. Only 15-30 % of liver metastases are amenable to potentially curative resection. Five year survival following primary and repeat liver resection has consistently been reported as 25-40 %. Future strategies focus at widening the indication and extending therapeutic options. The aim of neoadjuvant treatment of irresectable liver metastasis is the conversion to secondary resectability either via increasing residual liver mass (portal vein embolisation/2-stage resection) and/or reducing tumor load via chemotherapy („downsizing”). Current data suggest resectability following neoadjuvant chemotherapy in around 8 % of cases but varying between 1-33 %.

Schlüsselwörter

Lebermetastasen - neoadjuvante Therapie - Chemotherapie

Key words

liver metastases - neoadjuvant therapy - chemotherapy

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Priv. Doz. Dr. med. Markus Golling

Klinik für Allgemein- und Gefäßchirurgie · Johann Wolfgang Goethe-Universität

Theodor-Stern-Kai 7

60590 Frankfurt/Main

Phone: +49/69/63 01 50 80

Fax: +49/69/63 01 74 52

Email: Markus.Golling@kgu.de