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Präliminare Pfortaderligatur rechts vor erweiterter Hemihepatektomie bei synchronen kolorektalen Lebermetastasen

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Zusammenfassung

Einleitung

Bei Patienten mit kolorektalem Karzinom und großen synchronen Lebermetastasen, die nur mittels erweiterter Hemihepatektomie rechts R0 zu resezieren sind, kann zur Reduktion des operativen Risikos 2-zeitig vorgegangen werden.

Methoden

Der klinische Verlauf und die volumetrische Bewertung der Lebergröße wird für 3 Patienten beschrieben, bei denen der rechte Pfortaderast während der Resektion des Kolonkarzinoms ligiert wurde.

Ergebnisse

Die links lateralen Segmente der Leber zeigten ein Größenwachstum um A: 9,9%, B: 13,7%, C: 4,9% des Gesamtlebervolumens. Gleichzeitig atrophierte der nicht befallene Anteil des rechten Leberlappens um A: 36,7%, B: 36%, C: 6%, während die Metastasen im rechten Lappen um A: 26,8%, B: 22,3%, C: 1,2% wuchsen. Die erweiterte Hemihepatektomie konnte nach 7 Wochen bei allen 3 Patienten ohne Zeichen der Leberinsuffizienz mit dem Ergebnis einer R0-Resektion durchgeführt werden.

Schlussfolgerungen

Bei ausgewählten Patienten mit synchronen kolorektalen Lebermetastasen erscheint die Methode geeignet, das Risiko der erweiterten Hemihepatektomie rechts zu senken.

Abstract

Introduction

A two-step procedure is suggested to reduce the overall operative risk in patients with colorectal cancer and large synchronous liver metastases, which demand an extended right hemihepatectomy for R0 resection.

Methods

The clinical course and volumetric evaluation of the liver is described in three patients in whom preliminary ligation of the right branch of the portal vein was performed at the time of colon resection.

Results

The size of the left lateral lobes increased by 9.9%, 13.7%, and 4.9% of total liver volume, respectively. At the same time, the noninfiltrated part of the right lobes shrunk by 36.7%, 36%, and 6% ukereas metastatic growth was 26.8%, 22.3%, and 12%. After 7 weeks, extended right hemihepatectomy could be performed in all three patients without signs of hepatic insufficiency, yielding R0 resection.

Conclusion

Can reduce the risk for extended right hemihepatectomy in selected patients with synchronous colorectal liver metastases.

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Authors and Affiliations

  1. Klinik und Poliklinik für Visceral- und Gefäßchirurgie, Universität zu Köln, Köln

    A. H. Hölscher, K. Schleimer, K. T. E. Beckurts & D. L. Stippel

  2. Institut und Poliklinik für Radiologische Diagnostik, Universität zu Köln, Köln

    H. G. Brochhagen

  3. Klinik und Poliklinik für Visceral- und Gefäßchirurgie, Universität zu Köln, Joseph-Stelzmann-Straße 9, 50931 , Köln

    A. H. Hölscher

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  1. A. H. Hölscher
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  2. K. Schleimer
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  3. K. T. E. Beckurts
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  4. H. G. Brochhagen
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  5. D. L. Stippel
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Correspondence to A. H. Hölscher.

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Hölscher, A.H., Schleimer, K., Beckurts, K.T.E. et al. Präliminare Pfortaderligatur rechts vor erweiterter Hemihepatektomie bei synchronen kolorektalen Lebermetastasen. Chirurg 74, 860–865 (2003). https://doi.org/10.1007/s00104-003-0697-4

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  • DOI: https://doi.org/10.1007/s00104-003-0697-4

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