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

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