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Erschienen in: Wiener klinisches Magazin 3/2014

01.06.2014 | Chirurgie

Funktionserhalt und Funktionsverbesserung in der onkologischen Leberchirurgie

verfasst von: R. Öllinger, FACS Prof. Dr. J. Pratschke

Erschienen in: Wiener klinisches Magazin | Ausgabe 3/2014

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Zusammenfassung

Die onkologische Leberchirurgie ist für primäre Malignome der Leber wie auch Lebermetastasen der einzige kurative Ansatz. Resektionen an der Leber, die vor einigen Jahren noch als undenkbar galten, sind heute aufgrund von Fortschritten in Technik, Diagnostik, Patientenmanagement und -selektion sowie durch multimodale Konzepte erfolgreiche kurative Ansätze. Während heute weder für pharmakologische Interventionen zur Funktionsverbesserung der Leber noch für die Leberersatztherapie überzeugende Daten vorliegen, sind Leberfunktionstests, präoperative Maßnahmen (Cholangiodrainage, Pfortaderembolisation/-ligatur) und eine patientenadaptierte Operationsplanung für diese Therapieansätze maßgebend. Limitierender Faktor ist neben den anatomischen Voraussetzungen v. a. die Leberfunktion.
Literatur
1.
Zurück zum Zitat Eveno C, Karoui M, Gayat E et al (2013) Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections. HPB (Oxford) 15:359–364 Eveno C, Karoui M, Gayat E et al (2013) Liver resection for colorectal liver metastases with peri-operative chemotherapy: oncological results of R1 resections. HPB (Oxford) 15:359–364
2.
Zurück zum Zitat Haas RJ de, Wicherts DA, Flores E et al (2008) R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 248:626–637 PubMed Haas RJ de, Wicherts DA, Flores E et al (2008) R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 248:626–637 PubMed
3.
Zurück zum Zitat Dejong CHC (2013) Vascular reconstruction combined with liver resection for malignant tumours (Br J Surg 2013; 100: 1764–1775). Br J Surg 100:1776 PubMedCrossRef Dejong CHC (2013) Vascular reconstruction combined with liver resection for malignant tumours (Br J Surg 2013; 100: 1764–1775). Br J Surg 100:1776 PubMedCrossRef
4.
Zurück zum Zitat Truant S, Oberlin O, Sergent G et al (2007) Remnant liver volume to body weight ratio < or = 0.5 %: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204:22–33 PubMedCrossRef Truant S, Oberlin O, Sergent G et al (2007) Remnant liver volume to body weight ratio < or = 0.5 %: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204:22–33 PubMedCrossRef
5.
Zurück zum Zitat Okochi O, Kaneko T, Sugimoto H et al (2002) ICG pulse spectrophotometry for perioperative liver function in hepatectomy. J Surg Res 103:109–113 PubMedCrossRef Okochi O, Kaneko T, Sugimoto H et al (2002) ICG pulse spectrophotometry for perioperative liver function in hepatectomy. J Surg Res 103:109–113 PubMedCrossRef
6.
Zurück zum Zitat Zipprich A, Kuss O, Rogowski S et al (2010) Incorporating indocyanin green clearance into the Model for End Stage Liver Disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut 59:963–968 PubMedCrossRef Zipprich A, Kuss O, Rogowski S et al (2010) Incorporating indocyanin green clearance into the Model for End Stage Liver Disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut 59:963–968 PubMedCrossRef
7.
Zurück zum Zitat Stockmann M, Lock JF, Riecke B et al (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 250:119–125 PubMedCrossRef Stockmann M, Lock JF, Riecke B et al (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 250:119–125 PubMedCrossRef
8.
Zurück zum Zitat Denys A, Prior J, Bize P et al (2012) Portal vein embolization: what do we know? Cardiovasc Intervent Radiol 35:999–1008 PubMedCrossRef Denys A, Prior J, Bize P et al (2012) Portal vein embolization: what do we know? Cardiovasc Intervent Radiol 35:999–1008 PubMedCrossRef
9.
Zurück zum Zitat Nagino M, Kamiya J, Nishio H et al (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372 PubMedCentralPubMedCrossRef Nagino M, Kamiya J, Nishio H et al (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243:364–372 PubMedCentralPubMedCrossRef
10.
Zurück zum Zitat Simoneau E, Aljiffry M, Salman A et al (2012) Portal vein embolization stimulates tumour growth in patients with colorectal cancer liver metastases. HPB (Oxford) 14:461–468 Simoneau E, Aljiffry M, Salman A et al (2012) Portal vein embolization stimulates tumour growth in patients with colorectal cancer liver metastases. HPB (Oxford) 14:461–468
11.
Zurück zum Zitat Ardito F, Vellone M, Barbaro B et al (2013) Right and extended-right hepatectomies for unilobar colorectal metastases: impact of portal vein embolization on long-term outcome and liver recurrence. Surgery 153:801–810 PubMedCrossRef Ardito F, Vellone M, Barbaro B et al (2013) Right and extended-right hepatectomies for unilobar colorectal metastases: impact of portal vein embolization on long-term outcome and liver recurrence. Surgery 153:801–810 PubMedCrossRef
12.
Zurück zum Zitat Sala S, Ardiles V, Ulla M et al (2012) Our initial experience with ALPPS technique: encouraging results. Updates Surg 64:167–172 PubMedCrossRef Sala S, Ardiles V, Ulla M et al (2012) Our initial experience with ALPPS technique: encouraging results. Updates Surg 64:167–172 PubMedCrossRef
13.
Zurück zum Zitat Shindoh J, Vauthey J-N, Zimmitti G et al (2013) Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg 217:126–133 (discussion133–134) PubMedCrossRef Shindoh J, Vauthey J-N, Zimmitti G et al (2013) Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg 217:126–133 (discussion133–134) PubMedCrossRef
14.
Zurück zum Zitat Richardson AJ, Laurence JM, Lam VWT (2014) Use of pre-operative steroids in liver resection: a systematic review and meta-analysis. HPB (Oxford) 16:12–19 Richardson AJ, Laurence JM, Lam VWT (2014) Use of pre-operative steroids in liver resection: a systematic review and meta-analysis. HPB (Oxford) 16:12–19
15.
Zurück zum Zitat Gurusamy KS, Kumar Y, Pamecha V et al (2009) Ischaemic pre-conditioning for elective liver resections performed under vascular occlusion. Cochrane Database Syst Rev (1):CD007629 Gurusamy KS, Kumar Y, Pamecha V et al (2009) Ischaemic pre-conditioning for elective liver resections performed under vascular occlusion. Cochrane Database Syst Rev (1):CD007629
16.
Zurück zum Zitat Lam VWT, Laurence JM, Johnston E et al (2013) A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB (Oxford) 15:483–491 Lam VWT, Laurence JM, Johnston E et al (2013) A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB (Oxford) 15:483–491
17.
Zurück zum Zitat Eisele RM, Zhukowa J, Chopra S et al (2010) Results of liver resection in combination with radiofrequency ablation for hepatic malignancies. Eur J Surg Oncol 36:269–274 PubMedCrossRef Eisele RM, Zhukowa J, Chopra S et al (2010) Results of liver resection in combination with radiofrequency ablation for hepatic malignancies. Eur J Surg Oncol 36:269–274 PubMedCrossRef
18.
Zurück zum Zitat Kerkhove M-P van de, Jong KP de, Rijken AM et al (2003) MARS treatment in posthepatectomy liver failure. Liver Int 23(Suppl 3):44–51 PubMedCrossRef Kerkhove M-P van de, Jong KP de, Rijken AM et al (2003) MARS treatment in posthepatectomy liver failure. Liver Int 23(Suppl 3):44–51 PubMedCrossRef
Metadaten
Titel
Funktionserhalt und Funktionsverbesserung in der onkologischen Leberchirurgie
verfasst von
R. Öllinger
FACS Prof. Dr. J. Pratschke
Publikationsdatum
01.06.2014
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 3/2014
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-014-0218-8