Chirurgische Therapie von Lebermetastasen kolorektaler Karzinome

Zusammenfassung

Die Resektion von Lebermetastasen kolorektaler Karzinome ist bislang das einzige Behandlungsverfahren, dessen kurative Wirkung anhand eines ausreichend langen Nachbeobachtungszeitraums erwiesen ist. Die Indikation ist gegeben, wenn sämtliche Metastasen vollständig entfernbar sind, ausreichend Restparenchym erhalten werden kann und das Risiko des Eingriffs vertretbar ist. Kontraindikationen sind nicht resezierbare extrahepatische Tumoren und Lymphknotenmetastasen distal des Ligamentum hepatoduodenale. Die postoperative Letalität liegt unter 5 % und die 5-Jahres-Ü berlebensraten schwanken je nach Patientenselektion zwischen 20 und 40 %. Neuere Ansatzpunkte in der operativen Therapie sind die Erhöhung der Resektionsrate durch präoperative Pfortaderembolisation der tumortragenden Leberhälfte, die Kombination der Resektion mit lokaldestruierenden Verfahren und die neoadjuvante Chemotherapie, womit primär nicht resektable Metastasen in ein resektables Stadium übergeführt werden. Daneben ist die Prognoseverbesserung durch Reduzierung des Wiederauftretens der Metastasen in der Leber Ziel einer adjuvanten systemischen Chemotherapie, die in laufenden Studien überprüft wird. Die Resektion ist eine wesentliche, aber nicht die einzige therapeutische Option bei Lebermetastasen. Ihr Einsatz ist auch abhängig von der Leistungsfähigkeit anderer lokaldestruierender und systemischer Behandlungsverfahren. Für den Patienten ist die interdisziplinäre Absprache entscheidend, um die individuell optimale therapeutische Strategie zu finden.

Abstract

Resection is the only curative treatment of colorectal liver metastases proofed by a long-term follow-up. The operation is indicated if the metastases are completely removable with sufficient liver parenchyma remaining after resection and if the patient is fit for surgery. The resection is not indicated in cases with non resectable extrahepatic tumours and lymph node metastases distal the hepatoduodenal ligament. The postoperative mortality amounts to about 5 % and the 5-year-survival-rates range between 20 and 40 % depending on the selection of patients. Aims of new concepts of operative therapy are the improvement of resectability by preoperative portal vein embolization, the resection combined with local destructive methods and preoperative chemotherapy. Additionally, new drugs for adjuvant treatment after resection of metastases are studied. The interdisciplinary discussion of the course before and after therapy is essential for the individual optimal treatment.

Schlüsselwörter

Lebermetastasen - operative Therapie - kolorektales Karzinom

Key words

Liver metastases - colorectal carcinoma - surgical therapy

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