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DOI: 10.1055/s-0033-1350815
Fortschritt, Limitationen und Zukunft der onkologischen Leberchirurgie
Advances, Limitations and Prospects of Oncological Liver SurgeryPublication History
Publication Date:
16 October 2013 (online)
![](https://www.thieme-connect.de/media/zblchir/201402/lookinside/thumbnails/10.1055-s-0033-1350815-1.jpg)
Zusammenfassung
Wie in vielen Bereichen der modernen Medizin erfolgt auch die Behandlung primärer und sekundärer Lebertumoren zunehmend interdisziplinär. Die fortwährende Entwicklung auf den Gebieten der Chirurgie, Intensivmedizin, Onkologie, Radiologie und Transplantationsmedizin eröffnet vielversprechende neue Wege in der Therapie. Neue Kriterien für die Resektabilität von Leberherden tragen den verbesserten chirurgischen und technischen Möglichkeiten Rechnung und haben Einzug in die Konsensusleitlinien gefunden. Zu den Werkzeugen der modernen Leberchirurgie gehört die schnelle Induktion einer Leberhypertrophie vor ausgedehnter Leberresektion, ein Downstaging vorhandener Leberherde durch neoadjuvante Chemotherapie, minimalinvasive interventionelle Verfahren wie die Radiofrequenzablation oder die transarterielle Chemo- und Radioembolisation sowie die Lebertransplantation beim inoperablen hepatozellulären Karzinom.
Abstract
Modern oncological liver surgery continues to push the limits of resectability by incorporating an array of new developments in the fields of surgery, anaesthesia and intensive care, oncology, radiology and transplantation medicine. New criteria for determining the resectability of primary and secondary liver tumours have been developed and introduced into national consensus guidelines. Modern tools for improving oncological outcome include the rapid induction of liver hypertrophy prior to major liver resection, downstaging of tumours with advanced chemotherapy protocols, minimally invasive local therapies like radiofrequency ablation and chemo- or radioembolisation, and liver transplantation for non-resectable hepatocellular carcinoma.
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Literatur
- 1 Ekberg H, Tranberg KG, Andersson R et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986; 73: 727-731
- 2 Hughes KS, Simon R, Songhorabodi S et al. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence. Surgery 1986; 100: 278-284
- 3 Cady B, Jenkins RL, Steele GD et al. Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 1998; 227: 566-571
- 4 Hughes KS, Rosenstein RB, Songhorabodi S et al. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum 1988; 31: 1-4
- 5 Nordlinger BB, Guiguet MM, Vaillant JCJ et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie. Cancer 1996; 77: 1254-1262
- 6 Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist 2008; 13: 51-64
- 7 Schindl MJ, Redhead DN, Fearon K et al. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 2005; 54: 289-296
- 8 Rahbari NN, Garden OJ, Padbury R et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 2011; 149: 713-724
- 9 Ferrero A, Vigano L, Polastri R et al. Postoperative Liver Dysfunction and Future Remnant Liver: Where Is the Limit?. World J Surg 2007; 31: 1643-1651
- 10 Simmonds PC, Primrose JN, Colquitt JL et al. Surgical resection of hepatic metastases from colorectal cancer: A systematic review of published studies. Br J Cancer 2006; 94: 982-999
- 11 Mohammad WM, Martel G, Mimeault R et al. Evaluating agreement regarding the resectability of colorectal liver metastases: a national case-based survey of hepatic surgeons. HPB (Oxford) 2012; 14: 291-297
- 12 Schmiegel W, Pox C, Reinacher-Schick A et al. S3-Leitlinie „Kolorektales Karzinom“ Ergebnisse evidenzbasierter Konsensuskonferenzen am 6./7. Februar 2004 und am 8./9. Juni 2007 (für die Themenkomplexe IV, VI und VII). Z Gastroenterol 2008; 46: 1-73
- 13 Grundmann R, Hermanek P, Merkel S et al. Diagnostik und Therapie von Lebermetastasen kolorektaler Karzinome – Workflow. Zentralbl Chir 2008; 133: 267-284
- 14 Seehofer D, Neuhaus P. Kolorektale Lebermetastasen: Aktueller Stand der multimodalen Therapie. Zentralbl Chir 2011; 136: 343-351
- 15 de Haas RJ, Wicherts DA, Andreani P et al. Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg 2011; 253: 1069-1079
- 16 Lim KC, Chow PKH, Allen JC et al. Systematic review of outcomes of liver resection for early hepatocellular carcinoma within the Milan criteria. Br J Surg 2012; 99: 1622-1629
- 17 Ercolani G, Vetrone G, Grazi GL et al. Intrahepatic cholangiocarcinoma: primary liver resection and aggressive multimodal treatment of recurrence significantly prolong survival. Ann Surg 2010; 252: 107-114
- 18 Endo I, Gönen M, Yopp AC et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg 2008; 248: 84-96
- 19 Kissenkoetter S, Witzigmann H. Kriterien der Resektabilität von malignen extrahepatischen Gallengangstumoren. Zentralbl Chir 2012; 137: 32-37
- 20 Liu CL, Fan ST, Lo CM et al. Improved operative and survival outcomes of surgical treatment for hilar cholangiocarcinoma. Br J Surg 2006; 93: 1488-1494
- 21 Lehner F, Ramackers W, Bektas H et al. [Liver resection for non-colorectal, non-neuroendocrine liver metastases–is hepatic resection justified as part of the oncosurgical treatment?]. Zentralbl Chir 2009; 134: 430-436
- 22 Denys A, Prior J, Bize P et al. Portal vein embolization: what do we know?. Cardiovasc Intervent Radiol 2012; 35: 999-1008
- 23 de Graaf W, van Lienden KP, van den Esschert JW et al. Increase in future remnant liver function after preoperative portal vein embolization. Br J Surg 2011; 98: 825-834
- 24 Abulkhir A, Limongelli P, Healey AJ et al. Preoperative portal vein embolization for major liver resection. Ann Surg 2008; 247: 49-57
- 25 Adam R, Laurent A, Azoulay D et al. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors. Ann Surg 2000; 232: 777-785
- 26 Jaeck D, Oussoultzoglou E, Rosso E et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 2004; 240: 1037-1049
- 27 Vauthey JN, Chaoui A, Do KA et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 2000; 127: 512-519
- 28 Hoekstra LT, van Lienden KP, Doets A et al. Tumor progression after preoperative portal vein embolization. Ann Surg 2012; 256: 812-818
- 29 Schnitzbauer AA, Lang SA, Goessmann H et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012; 255: 405-414
- 30 Neumann UP, Seehofer D, Neuhaus P. The surgical treatment of hepatic metastases in colorectal carcinoma. Dtsch Arztebl Int 2010; 107: 335-342
- 31 Lam VWT, Spiro C, Laurence JM et al. A systematic review of clinical response and survival outcomes of downsizing systemic chemotherapy and rescue liver surgery in patients with initially unresectable colorectal liver metastases. Ann Surg Oncol 2012; 19: 1292-1301
- 32 Adam R, Wicherts DA, de Haas RJ et al. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure?. J Clin Oncol 2009; 27: 1829-1835
- 33 Cauchy F, Aussilhou B, Dokmak S et al. Reappraisal of the risks and benefits of major liver resection in patients with initially unresectable colorectal liver metastases. Ann Surg 2012; 256: 746-754
- 34 Folprecht G, Gruenberger T, Bechstein WO et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 2010; 11: 38-47
- 35 Garufi C, Torsello A, Tumolo S et al. Cetuximab plus chronomodulated irinotecan, 5-fluorouracil, leucovorin and oxaliplatin as neoadjuvant chemotherapy in colorectal liver metastases: POCHER trial. Br J Cancer 2010; 103: 1542-1547
- 36 Gruenberger B, Scheithauer W, Punzengruber R et al. Importance of response to neoadjuvant chemotherapy in potentially curable colorectal cancer liver metastases. BMC Cancer 2008; 8: 120
- 37 Adam R, Pascal G, Castaing D et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases?. Ann Surg 2004; 240: 1052-1061
- 38 McGahan JP, Brock JM, Tesluk H et al. Hepatic ablation with use of radio-frequency electrocautery in the animal model. J Vasc Interv Radiol 1992; 3: 291-297
- 39 Livraghi T, Solbiati L, Meloni MF et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226: 441-451
- 40 Mulier S, Mulier P, Ni Y et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg 2002; 89: 1206-1222
- 41 Rhim H, Lim HK, Kim YS et al. Radiofrequency ablation of hepatic tumors: lessons learned from 3000 procedures. J Gastroenterol Hepatol 2008; 23: 1492-1500
- 42 Mulier S, Ni Y, Jamart J et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 2005; 242: 158-171
- 43 Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011; 98: 1210-1224
- 44 Siperstein AE, Berber E, Ballem N et al. Survival after radiofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg 2007; 246: 559-565
- 45 Kim KH, Yoon YS, Yu CS et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc 2011; 81: 25-34
- 46 Abdalla EK, Vauthey J-N, Ellis LM et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-825
- 47 Cirocchi R, Trastulli S, Boselli C et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012; (6) CD006317
- 48 Memon K, Lewandowski RJ, Riaz A et al. Chemoembolization and radioembolization for metastatic disease to the liver: available data and future studies. Curr Treat Options Oncol 2012; 13: 403-415
- 49 Orlando A, Leandro G, Olivo M et al. Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: meta-analysis of randomized controlled trials. Am J Gastroenterol 2009; 104: 514-524
- 50 Bouza C, López-Cuadrado T, Alcázar R et al. Meta-analysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma. BMC Gastroenterol 2009; 9: 31
- 51 Lau WY, Leung TW, Yu SC et al. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003; 237: 171-179
- 52 Vogl TJ, Müller PK, Hammerstingl RR et al. Malignant liver tumors treated with MR imaging-guided laser-induced thermotherapy: technique and prospective results. Radiology 1995; 196: 257-265
- 53 Eichler KK, Zangos SS, Gruber-Rouh TT et al. Magnetic resonance-guided laser-induced thermotherapy in patients with oligonodular hepatocellular carcinoma: long-term results over a 15-year period. J Clin Gastroenterol 2012; 46: 796-801
- 54 Vogl TJ, Mack M, Straub R et al. Perkutane interstitielle Thermotherapie maligner Lebertumoren. Fortschr Röntgenstr 2000; 172: 12-22
- 55 Lee HY, Rhim H, Lee MW et al. Early diffuse recurrence of hepatocellular carcinoma after percutaneous radiofrequency ablation: analysis of risk factors. Eur Radiol 2013; 23: 190-197
- 56 Vogl TJ, Müller PK, Mack MG et al. Liver metastases: interventional therapeutic techniques and results, state of the art. Eur Radiol 1999; 9: 675-684
- 57 Lee FT, Mahvi DM, Chosy SG et al. Hepatic cryosurgery with intraoperative US guidance. Radiology 1997; 202: 624-632
- 58 Jang JW, You CR, Kim CW et al. Benefit of downsizing hepatocellular carcinoma in a liver transplant population. Aliment Pharmacol Ther 2010; 31: 415-423
- 59 De Luna W, Sze DY, Ahmed A et al. Transarterial chemoinfusion for hepatocellular carcinoma as downstaging therapy and a bridge toward liver transplantation. Am J Transplant 2009; 9: 1158-1168
- 60 Zhang Z, Liu Q, He J et al. The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma. Cancer 2000; 89: 2606-2612
- 61 Choi GH, Kim DH, Kang CM et al. Is preoperative transarterial chemoembolization needed for a resectable hepatocellular carcinoma?. World J Surg 2007; 31: 2370-2377
- 62 Chua TC, Liauw W, Saxena A et al. Systematic review of neoadjuvant transarterial chemoembolization for resectable hepatocellular carcinoma. Liver Int 2010; 30: 166-174
- 63 Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334: 693-699
- 64 Mazzaferro V, Bhoori S, Sposito C et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence‐based analysis of 15 years of experience. Liver Transpl 2011; 17 (Suppl. 02) S44-S57
- 65 Pomfret EA, Washburn K, Wald C et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl 2010; 16: 262-278
- 66 Bhoori S, Sposito C, Germini A et al. The challenges of liver transplantation for hepatocellular carcinoma on cirrhosis. Transpl Int 2010; 23: 712-722