Zusammenfassung
In dieser Arbeit wird der aktuelle Wissensstand zu Indikation und Ergebnissen operativer und multimodaler Therapie von Lebermetastasen kolorektaler Karzinome zusammengefasst. Die chirurgische Therapie eingebettet in ein multimodales Therapiekonzept bietet weiterhin die größte Heilungschance. Voraussetzung hierfür ist die richtige Patientenselektion auf der Basis von Prognosescores und einem modernen präoperativen Staging inklusive Staging Laparoskopie mit laparoskopischen Ultraschall. Verbesserungen in der chirurgischen Technik und der Intensivtherapie haben zu einer Verminderung der postoperativen Morbidität (< 25 %) und Mortalität (< 5 %) geführt. Auch Re-Resektionen bei singulären Rezidivmetasasen sind indiziert und in erfahrenen Zentren mit vertretbarem Risiko durchführbar. Weitere Fortschritte sind durch neue multimodal chirurgische Therapiekonzepte wie Downsizing durch Chemotherapie oder Chemoembolisation sowie Behandlungssplitting (Resektion und Thermoablation) zu erwarten.
Abstract
This paper reviews current indications and results of surgical and multimodal therapy of liver metastases from colorectal cancer. Surgery in combination with other therapeutic modalities offers the highest chance for cure. Accurate patient selection on the basis of prognostic scores and modern preoperative staging including laparoscopy is essential to obtain appropriate results. Improvements in the surgical technique and intensive care have led to a reduction of morbidity (< 25 %) and mortality (< 5 %). Repeat resections of solitary recurrences are justified and can be performed in experienced institutes with reasonable risk. Further advances can be expected by new multimodal therapy regimes such as downsizing (chemotherapy, chemoembolization) and therapeutic splitting (surgery and radiofrequency ablation).
Schlüsselwörter
Kolorektales Karzinom - Lebermetastasen - Resektion - Multimodale Therapie
Key words
Surgery - colorectal cancer - liver metastases - multimodal therapy
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P. M. Schlag
Klinik für Chirurgie und Chirurgische Onkologie · Charité Campus Buch im Helios Klinikum Berlin
Lindenberger Weg 80
13122 Berlin
Email: schlag@rrk.charite-buch.de
