Chirurgische Resektion kolorektaler Lebermetastasen
Tóm tắt
Derzeit ist die Leberresektion kolorektaler Metastasen unter potenziell kurativer Zielsetzung bei 15–20% der Patienten durchführbar. Chirurgisch ist die Erzielung eines R0-Stadiums entscheidend. Die perioperative Letalität hängt wesentlich vom dem Ausmaß der Resektion (Standardresektion [Klasse I], erweiterte Resektion [Klasse II]) ab. Versuche der intra- und postoperativen Risikominimierung durch medikamentöse oder ischämische Präkonditionierung sind nicht ausreichend validiert und ihr klinischer Wert anzuzweifeln. Unter Berücksichtigung dieser Faktoren beträgt die 5-Jahres-Überlebensrate bei primärer, aber auch bei wiederholter Metastasenresektion weiterhin um 30–40%. Eine weitere Prognoseverbesserung erscheint in erster Linie durch eine Erweiterung der Indikations- und Therapiespektren möglich. Entscheidende Bedeutung wird dabei der Konversion irresektabler und potenziell resektabler Metastasen in eine chirurgische Resektabilität zukommen. Dies kann präoperativ durch eine Embolisation mit Verkleinerung des tumortragenden Anteils/Vergrößerung des Leberrestgewebes oder neoadjuvante Chemotherapiekonzepte, intraoperativ mittels zweitzeitiger Resektion oder eine Kombination resezierender mit lokal ablativen Verfahren erreicht werden. Alle vorgeschlagenen Verfahren bei primär inoperablen Befunden sollten in klinischen Studien systematisch überprüft werden.
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