Fortschritt, Limitationen und Zukunft der onkologischen Leberchirurgie

 

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Zusammenfassung

Wie in vielen Bereichen der modernen Medizin erfolgt auch die Behandlung primärer und sekundärer Lebertumoren zunehmend interdisziplinär. Die fortwährende Entwicklung auf den Gebieten der Chirurgie, Intensivmedizin, Onkologie, Radiologie und Transplantationsmedizin eröffnet vielversprechende neue Wege in der Therapie. Neue Kriterien für die Resektabilität von Leberherden tragen den verbesserten chirurgischen und technischen Möglichkeiten Rechnung und haben Einzug in die Konsensusleitlinien gefunden. Zu den Werkzeugen der modernen Leberchirurgie gehört die schnelle Induktion einer Leberhypertrophie vor ausgedehnter Leberresektion, ein Downstaging vorhandener Leberherde durch neoadjuvante Chemotherapie, minimalinvasive interventionelle Verfahren wie die Radiofrequenzablation oder die transarterielle Chemo- und Radioembolisation sowie die Lebertransplantation beim inoperablen hepatozellulären Karzinom.

Abstract

Modern oncological liver surgery continues to push the limits of resectability by incorporating an array of new developments in the fields of surgery, anaesthesia and intensive care, oncology, radiology and transplantation medicine. New criteria for determining the resectability of primary and secondary liver tumours have been developed and introduced into national consensus guidelines. Modern tools for improving oncological outcome include the rapid induction of liver hypertrophy prior to major liver resection, downstaging of tumours with advanced chemotherapy protocols, minimally invasive local therapies like radiofrequency ablation and chemo- or radioembolisation, and liver transplantation for non-resectable hepatocellular carcinoma.

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