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
