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Viszeralchirurgie 2004; 39(2): 129-137
DOI: 10.1055/s-2004-818744
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© Georg Thieme Verlag Stuttgart · New York

Grenzen und Perspektiven ablativer Verfahren bei Lebertumoren

Limitations and Perspectives of Ablative Procedures in Liver TumorsJ.-P. Ritz1 , H. J. Buhr1
  • 1Chirurgische Klinik und Poliklinik I, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin
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Publication History

Publication Date:
21 April 2004 (online)

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Zusammenfassung

Primäre und sekundäre bösartige Neubildungen in der Leber stellen eine der häufigsten onkologischen Erkrankungen dar. Bislang steht die chirurgische Resektion als das einzige potenziell kurative Verfahren für die Behandlung von Lebertumoren zur Verfügung. Zum Zeitpunkt der Diagnosestellung kann jedoch aus prognostischen oder operationstechnischen Gründen nur eine Minderheit der Patienten einer chirurgischen Therapie zugeführt werden. Für diese Patientengruppe wurden in den letzten Jahren lokale Ablationsverfahren als Alternative zur chirurgischen Resektion entwickelt. Hierzu zählen laserinduzierte Thermotherapie, Radiofrequenztherapie, Kryotherapie, Mikrowellenkoagulation und perkutane Alkoholinstillation. Vor allem die laserinduzierte Thermotherapie und die Radiofrequenztherapie haben dabei breite klinische Verbreitung gefunden. Diese Verfahren bieten die Möglichkeit, komplikationsarm und minimalinvasiv Tumoren in situ zu zerstören. Obwohl randomisierte Studien bislang fehlen, scheinen vor allem Patienten mit lokal begrenzter Tumorerkrankung hiervon zu profitieren. Begrenzt wird der klinische Einsatz der Ablation vor allem durch onkologische und technische Kriterien. Hierzu zählen der Ausschluss einer systemischen Tumorerkrankung, die Induktion ausreichend großer Läsionen mit vollständiger intraläsionärer Tumorzerstörung und die Beurteilung des Therapieerfolges durch ein geeignetes Monitoringverfahren. Die lokale Ablation erweitert das Spektrum der therapeutischen Möglichkeiten für Patienten mit Lebertumoren und bietet unter Berücksichtigung strenger Indikationsstellung und Ausnutzung der technischen Möglichkeiten eine effektive Alternative zur chirurgischen Resektion.

Abstract

Primary and secondary malignant neoplasms in the liver are among the most common oncological diseases. Surgical resection is the only potentially curative procedure available thus far for the treatment of liver tumors. At the time of diagnosis, however, only a minority of patients can undergo surgery for prognostic or technical reasons. In recent years, local ablation procedures have been developed as an alternative to surgery for this patient group. They include laser-induced thermotherapy, radiofrequency therapy, cryotherapy, microwave coagulation and percutaneous alcohol installation. Especially laser-induced thermotherapy and radiofrequency therapy are widely applied in the clinical routine. These procedure enable the minimally invasive destruction of tumors in situ with few complications. Though randomized studies have not yet been performed, particularly patients with local tumor disease seem to profit from these treatments. However, the clinical application of ablation is especially limited by oncological and technical criteria. They include the exclusion of systemic tumor disease, the induction of sufficiently large lesions with complete intralesional tumor destruction and the evaluation of treatment success by a suitable monitoring procedure. Local ablation broadens the spectrum of therapeutic options for patients with liver tumors and is an effective alternative to surgical resection when adhering to strict indicational criteria and exploiting the technical possibilities.

Schlüsselwörter

Lebertumoren - Lebermetastasen - lokale Verfahren - In-situ-Ablation - laserinduzierte Thermotherapie - Radiofrequenztherapie - Kryotherapie

Key words

Liver tumors - liver metastases - local ablation - liver - In-situ ablation - radiofrequency - laserinduced thermotherapy - cryotherapy

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Dr. med. J.-P. Ritz

Chirurgische Klinik und Poliklinik I

Charité Universitätsmedizin Berlin

Campus Benjamin Franklin

Hindenburgdamm 30

12200 Berlin

Phone: ++49-30-84 45-25 43

Fax: ++49-30-84 45-27 40

Email: joerg-peter.ritz@charite.de