Viszeralchirurgie 2004; 39(5): 345-349
DOI: 10.1055/s-2004-820421

© Georg Thieme Verlag Stuttgart · New York

Chirurgische und multimodale Therapie von Lebermetastasen kolorektaler Karzinome

Surgery and Multimodal Therapy of Liver Metastases from Colorectal CancerP. M. Schlag1 , M. Hünerbein1
  • 1Klinik für Chirurgie und Chirurgische Onkologie, Charité Campus Buch im Helios Klinikum Berlin
Further Information

Publication History

Publication Date:
29 September 2004 (online)


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.


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).


  • 1 Adam R, Bismuth H, Castaing D, Waechter F, Navarro F, Abascal A, Majno P, Engerran L. Repeat hepatectomy for colorectal liver metastases.  Ann Surg. 1997;  225 51-62
  • 2 Bleicher R J, Allegra D P, Nora D T, Wood T F, Foshag L J, Bilchik A J. Radiofrequency Ablation in 447 Complex Unresectable Liver Tumors: Lessons Learned.  Ann Surg Oncol. 2003;  10 52-58
  • 3 Fong Y, Fortner J, Sun R L, Brennan M F, Blumgart L H. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1 001 consecutive cases.  Ann Surg. 1999;  230 309-321
  • 4 Goletti O, Celona G, Galatioto C, Viaggi B, Lippolis P V, Pieri L. et al . Is laparoscopic sonography a reliable and sensitive procedure for staging colorectal cancer? A comparative study.  Surg Endosc. 1998;  12 1236-1241
  • 5 Helmberger T, Gregor M, Holzknecht N, Gauger J, Rau H, Reiser M F. [Comparison of dual-phase helical CT with native and ferum oxide-enhanced magnetic resonance imaging in detection and characterization of focal liver lesions].  Radiologe. 1999;  39 678-684
  • 6 Hohenberger P, Schlag P M, Gerneth T, Herfarth C. Preoperative and postoperative carcinoembryonic antigen determinations in hepatic resections for colorectal metastases - predictive value and implications for adjuvant treatment based on multivariate analysis.  Ann Surg. 1994;  219 135-143
  • 7 Hünerbein M, Rau B, Hohenberger P, Schlag P M. Value of laparoscopic ultrasound for staging of gastrointestinal tumors.  Chirurg. 2001;  72 914-919
  • 8 Hughes K S, Simon R, Songhorabodi S, Adson M A, Ilstrup D M, Fortner J G, Maclean B J, Foster J H, Daly J M, Fitzherbert D. et al . Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of patterns of recurrence.  Surgery. 1986;  100 278-842
  • 9 Hughes K S, Simon R, Songhorabodi S, Adson M A, Ilstrup D M, Fortner J G, Maclean B J, Foster J H, Daly J M, Fitzherbert D, Sugarbaker P H, Iwatsuki S, Starzl T, Ramming K P, Longmire W P, O'Toole K, Petrelli N J, Herrera L, Cady B, McDermott W, Nims T, Enker W E, Coppa G F, Blumgart L H, Bradpiece H, Urist M, Aldrete J S, Schlag P, Hohenberger P, Steele F, Hodgson W J, Hardy T G, Harbora D, McPherson T A, Lim C, Dillon D, Happ R, Ripepi P, Villella E, Rossi R, Remine S G, Oster M, Connolly D P, Abrams J, Al-Jurf A, Hobbs K EF, Li M KW, Howard T, Lee E. Resection of the liver for colorectal carcinoma metastases: A multi-institutional study of indications for resection.  Surgery. 1988;  103 278-288
  • 10 Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant J C, Balladur P, Nordlinger B,. Association Française de Chirurgie . Long-term survival following resection of colorectal hepatic metastases.  Br J Surg. 1997;  84 977-980
  • 11 John T G, Greig J D, Crosbie J L, Miles W F, Garden O J. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound.  Ann Surg. 1994;  220 711-719
  • 12 Lamade W, Glombitza G, Fischer L, Chiu P, Cardenas C E, Thorn M, Meinzer H-P, Grenacher L, Bauer H, Lehnert T, Herfarth C. The Impact of 3-Dimensional Reconstructions on Operation Planning in Liver Surgery.  Arch Surg. 2000;  135 1256-1261
  • 13 Lehnert T, Knaebel H P, Dück M, Bülzebruck H P, Herfarth C. Sequential hepatic and pulmonary resections for metastatic colorectal cancer.  Br J Surg. 1999;  86 241-243
  • 14 Lorenz M, Muller H H, Schramm H, Gassel H J, Rau H G, Ridwelski K, Hauss J, Stieger R, Jauch K W, Bechstein W O, Encke A. German Cooperative on Liver Metastases (Arbeitsgruppe Lebermetastasen) . Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracil and folinic acid for liver metastases of colorectal cancer.  Ann Surg. 1998;  228 756-762
  • 15 Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, Jarnagin W, Blumgart L. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis.  J Am Coll Surg. 2003;  197 233-242
  • 16 Muratore A, Polastri R, Bouzari H, Vergara V, Ferrero A, Capussotti L. Repeat hepatectomy for colorectal liver metastases: A worthwhile operation?.  J Surg Oncol. 2001;  76 127-132
  • 17 Nordlinger B, Jaeck D, Guiguet M, Vaillant J C. et al .Surgical resection of hepatic metastases. Multicentric retrospective study by French Association of Surgery. Nordlinger B, Jaeck D (eds). In: Treatment of Hepatic Metastases of Colorectal Cancer. Springer, Paris, Berlin 1992; 129-161
  • 18 Oshowo A, Gillams A, Harrison E, Lees W R, Taylor I. Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases.  Br J Surg. 2003;  90 1240-1243
  • 19 Penn I. Hepatic transplantation for primary and metastatic cancers of the liver.  Surgery. 1991;  110 726-735
  • 20 Rau H G, Wichmann M W, Schinkel S, Buttler E, Pickelmann S, Schauer R, Schildl F W. Surrgical techniques in hepatic resections: Ultrasonic aspirator versus Jet-Cutter. A prospective randomized clinical trial.  Zentralbl Chir. 2001;  126 586-590
  • 21 Rodgers M S, McCall J L. Surgery for colorectal liver metastases with hepatic lymph node involvement: a systematic review.  Br J Surg. 2000;  87 1142-1155
  • 22 Ruers T, Bleichrodt R P. Treatment of liver metastases: an update on the possibilities and results.  Eur J Cancer. 2002;  38 1013-1033
  • 23 Schlag P, Hohenberger P, Herfarth C. Resection of liver metastases in colorectal cancer. Competitive analysis of treatment results in synchronous versus metachronous metastases.  Eur J Surg Oncol. 1990;  16 360-365
  • 24 Schlag P M, Hünerbein M, Ulmer C, Graschew G. Förderung der Interdisziplinarität in der Chirurgie durch Telematik.  Chirurg. 2004;  75 411-416
  • 25 Solbiati L, Livraghi T, Goldberg S N, Ierace T, Meloni F, Dellanoce M, Cova L, Halpern E F, Gazelle G S. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.  Radiology. 2001;  221 159-166
  • 26 Vogl T J, Muller P K, Mack M G. et al . Liver metastases: Interventional therapeutic techniques and results, state of the art.  Eur Radiol. 1999;  9 675-684
  • 27 Wein A, Riedel C, Köckerling F, Haack A, Brückl W, Hohenberger W, Hahn E G. Successful Neoadjuvant Chemotherapy of Nonresectable Colorectal Liver Metastases: An Interdisciplinary Approach.  Onkologie. 1999;  22 54-56
  • 28 Yasui K, Hirai T, Kato T, Torii A, Uesaka K, Morimoto T, Kodera Y, Yamamura Y, Kito T, Hamajima N. A new macroscopic classification predicts prognosis for patient with metastases from colorectal cancer.  Ann Surg. 1997;  226 582-586

P. M. Schlag

Klinik für Chirurgie und Chirurgische Onkologie · Charité Campus Buch im Helios Klinikum Berlin

Lindenberger Weg 80

13122 Berlin