Ablative Verfahren in der Therapie von Lebermetastasen

Zusammenfassung

Wenn keine extrahepatischen Metastasen vorliegen, kann ein verbessertes Überleben mit chirurgischen und interventionellen Techniken erreicht werden. Interventionelle Techniken sind entweder definiert als perkutane oder intraoperative Laparoskopie bzw. die Anwendung von thermischer Ablation. In diesem Review konzentrieren wir uns hierbei auf die beiden etablierten Techniken der Radiofrequenzablation (RFA) und der Mikrowellenablation (MWA) zur Therapie von kolorektalen Lebermetastasen. Diese beiden Techniken erlauben eine sichere Ablation von Metastasen bis zu 3 cm Größe und haben eine niedrige Komplikationsrate. In aktuellen Leitlinien haben beide Therapien ihren Stellenwert. Im Falle von schwierig zu resezierenden Metastasen stellen sie eine gute Alternative dar. Weiterhin können sie in Kombination mit Chirurgie eingesetzt werden, um das chirurgische Trauma zu reduzieren. Bei Rezidivmetastasen kann die Durchführung einer Intervention aufgrund des operativen Traumas niedrigere Morbidität für den Patienten bedeuten. Darüber hinaus sind die interventionellen Verfahren in Kombination mit einer systemischen Therapie der alleinigen Chemotherapie überlegen.

Abstract

In the absence of extrahepatic metastases, improved survival can be achieved with surgical and interventional techniques. In resectable patients the resection of liver metastases can be performed in curative intention. Interventional techniques are defined either as percutaneous or intraoperative laparoscopy, applications of thermal ablation. In this review, we concentrate on the most established ablative techniques of radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of colorectal liver metastases. These techniques allow safe ablation of metastases of up to 3 cm and have a low complication rate. In the current recommendations and guidelines, interventional therapies can be used for tumours that are surgically difficult to resect, in combination with surgery to reduce the surgical trauma or – in case of recurrent metastases – to avoid complicated repeat surgeries. Interventional therapies in combination with chemotherapy are superior to chemotherapy alone and should be considered especially in irresectable situations.

Schlüsselwörter

Ablation - Intervention - Lebermetastasen - Resektion

Key words

ablation - intervention - surgery - colorectal liver metastases

• Literatur

• 1 Creasy JM, Sadot E, Koerkamp BG. et al. Actual 10-year survival after hepatic resection of colorectal liver metastases: what factors preclude cure?. Surgery 2018; 163: 1238-1244
• 2 Clavien PA, Petrowsky H, DeOliveira ML. et al. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 2007; 356: 1545-1559
• 3 Lam VWT, Laurence JM, Johnston E. et al. A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB (Oxford) 2013; 15: 483-491
• 4 Moris D, Pawlik TM. Personalized treatment in patients with colorectal liver metastases. J Surg Res 2017; 216: 26-29
• 5 Roberts KJ, Sutton AJ, Prasad KR. et al. Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases. Br J Surg 2015; 102: 388-398
• 6 Vogl TJ, Lahrsow M, Albrecht MH. et al. Survival of patients with non-resectable, chemotherapy-resistant colorectal cancer liver metastases undergoing conventional lipiodol-based transarterial chemoembolization (cTACE) palliatively versus neoadjuvantly prior to percutaneous thermal ablation. Eur J Radiol 2018; 102: 138-145
• 7 Vogl TJ, Emam A, Naguib NN. et al. How effective are percutaneous liver-directed therapies in patients with non-colorectal liver metastases?. Viszeralmedizin 2015; 31: 406-413
• 8 Gruber-Rouh T, Marko C, Thalhammer A. et al. Current strategies in interventional oncology of colorectal liver metastases. Br J Radiol 2016; 89: 20151060
• 9 Yu J, Liang P, Yu X. et al. A comparison of microwave ablation and bipolar radiofrequency ablation both with an internally cooled probe: Results in ex vivo and in vivo porcine livers. Eur J Radiol 2011; 79: 124-130
• 10 Takahashi H, Kahramangil B, Kose E. et al. A comparison of microwave thermosphere versus radiofrequency thermal ablation in the treatment of colorectal liver metastases. HPB (Oxford) 2018; 20: 1157-1162
• 11 Hoffmann R, Rempp H, Keßler DE. et al. MR-guided microwave ablation in hepatic tumours: initial results in clinical routine. Eur Radiol 2017; 27: 1467-1476
• 12 Groeschl RT, Pilgrim CHC, Hanna EM. et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg 2014; 259: 1195-1200
• 13 Vogl TJ, Farshid P, Naguib NN. et al. Thermal ablation of liver metastases from colorectal cancer: radiofrequency, microwave and laser ablation therapies. Radiol Med 2014; 119: 451-461
• 14 Vogl TJ, Hagar A, Nour-Eldin NA. et al. High-frequency versus low-frequency microwave ablation in malignant liver tumours: evaluation of local tumour control and survival. Int J Hyperthermia 2016; 32: 868-875
• 15 De Cobelli F, Marra P, Ratti F. et al. Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions: New advances in interventional oncology: state of the art. Med Oncol 2017; 34: 49
• 16 Abbott DE, Sohn VY, Hanseman D. et al. Cost-effectiveness of simultaneous resection and RFA versus 2-stage hepatectomy for bilobar colorectal liver metastases. J Surg Oncol 2014; 109: 516-520
• 17 Meijerink MR, Puijk RS, van Tilborg AAJM. et al. Radiofrequency and microwave ablation compared to systemic chemotherapy and to partial hepatectomy in the treatment of colorectal liver metastases: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 2018; 41: 1189-1204
• 18 van Amerongen MJ, Jenniskens SFM, van den Boezem PB. et al. Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases – a meta-analysis. HPB (Oxford) 2017; 19: 749-756
• 19 Tanis E, Nordlinger B, Mauer M. et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 2014; 50: 912-919
• 20 Sasaki K, Margonis GA, Andreatos N. et al. Combined resection and RFA in colorectal liver metastases: stratification of long-term outcomes. J Surg Res 2016; 206: 182-189
• 21 Ruers T, Van Coevorden F, Punt CJ. et al. Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial. J Natl Cancer Inst 2017; 109 DOI: 10.1093/jnci/djx015.
• 22 Van Cutsem E, Cervantes A, Adam R. et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27: 1386-1422
• 23 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Kolorektales Karzinom. Langversion 2.1, 2019. AWMF Registrierungsnummer: 021/007OL. Im Internet: https://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/ Stand: 12.03.2019
• 24 Hof J, Joosten HJ, Havenga K. et al. Radiofrequency ablation is beneficial in simultaneous treatment of synchronous liver metastases and primary colorectal cancer. PLoS One 2018; 13: e0193385
• 25 Hof J, Wertenbroek MW, Peeters PM. et al. Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases. Br J Surg 2016; 103: 1055-1062
• 26 Puijk RS, Ruarus AH, Vroomen LGPH. et al. Colorectal liver metastases: surgery versus thermal ablation (COLLISION) – a phase III single-blind prospective randomized controlled trial. BMC Cancer 2018; 18: 821