Chirurgische therapie von lebermetastasen therapieverfahren, ergebnisse und prognosefaktoren

Riesener, K.-P.; Winkeltau, G.; Klemm, M.; Schumpelick, Volker

doi:10.1007/bf00191577

Cited by 8 publications

(3 citation statements)

References 36 publications

(25 reference statements)

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“…Der Anteil groûer und erweiterter Leberresektionen (Hemihepat-ektomie, erweiterte Hemihepatektomie und extracorporale Leberesektionen) lag in unserer Serie mit 58 % aller Resektionen wesentlich höher als in vergleichbaren Arbeiten, in denen zum gröûten Teil vorwiegend atypische Resektionen oder Segmentektomien zum Einsatz kamen [21,25,27,29]. Der Anteil groûer und erweiterter Leberresektionen (Hemihepat-ektomie, erweiterte Hemihepatektomie und extracorporale Leberesektionen) lag in unserer Serie mit 58 % aller Resektionen wesentlich höher als in vergleichbaren Arbeiten, in denen zum gröûten Teil vorwiegend atypische Resektionen oder Segmentektomien zum Einsatz kamen [21,25,27,29].…”

Section: Diskussionunclassified

Ergebnisse der Resektion nichtcolorectaler nichtneuroendokriner Lebermetastasen

Lang

Nussbaum

Weimann

et al. 1999

Chirurg

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Over a period of 11 years a total of 140 liver resections for non-colorectal, non-neuroendocrine hepatic metastases were performed in 127 patients (73 women, 54 men; median age 53 years). There were 120 first, 14 second and 6 third liver resections. Primary tumors were: breast cancer (n = 34), leiomyosarcoma (n = 20), pancreatic cancer (n = 16), renal cell carcinoma (n = 13), melanoma (n = 9), gastric cancer (n = 9), lung cancer (n = 6) and adrenal cancer (n = 6) and miscellaneous tumors (n = 14). Extrahepatic tumor manifestation (including synchronous primary tumors) was found in 69/140 cases (49%); 61 of 120 patients with a first liver resection had extrahepatic tumor (51%). In the 120 first liver resections, 82 (68%) R0, 13 (11%) R1 and 25 (21%) R2 excisions were possible. Median survival after first liver resection was 20 months; after R0 resection a median survival of 28 months and after R1/2 resection of 8 months was achieved. The 5-year survival rate was 16% for the total group, 24% in patients with R0 resection and 0% for R1/2 resections. After a second liver resection (n = 14) there was a median survival of 28 months (5-year-survival-rate of 21%) for all patients and of 41 months (5-year survival rate 38%) after R0 resection. Morbidity and mortality after the first liver resection were 32.5% and 5.8%, respectively. In patients without extrahepatic tumor at the time of the first liver resection a median survival of 32 months (5-year survival rate 25%) and 7 months was achieved after R0 resection and R1/2 resection, respectively. In case of extrahepatic tumor the median survival was 24 months (5-year survival rate 23%) for R0 resection compared to 8 months after R1/2 resection. These data suggest that not the presence of extrahepatic tumor but rather the possibility of a R0 resection is most decisive for the prognosis after liver resection. We conclude that patients with liver metastases of non-colorectal, non-neuroendocrine tumors may benefit from liver resection. Similar to colorectal metastases, a second or third liver resection can be worthwhile in selected cases. Even in more unfavorable tumor entities, several cases of long-term survival were observed after surgical therapy. Therefore, the indication for liver resection should be considered carefully in every single case.

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Section: Diskussionunclassified

Ergebnisse der Resektion nichtcolorectaler nichtneuroendokriner Lebermetastasen

Lang

Nussbaum

Weimann

et al. 1999

Chirurg

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“…Die bislang hierzu überwiegend eingesetzten Substanzen FUDR und 5-FU haben eine nachgewiesene Wirksamkeit bei colorectalen Tumoren und ihren Metastasen [27]. In unseren eigenen Untersuchungen sowie in verschiedenen anderen Studien konnte ein Einfluû der Metastasenzahl auf die Überlebenszeit nach R0-Resektion nicht nachgewiesen werden [10,25,28]. Nachteile sind jedoch die bei ho-Abb.…”

Section: Diskussionunclassified

“…Es werden regelhaft 5-Jahres-Überlebensraten von 20±40 % berichtet [7,9,17,25,26,28]. Bei 50 Patienten wurde ein Portsystem zur postoperativen adjuvanten regionalen Chemotherapie in die A. hepatica implantiert.…”

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Adjuvante regionale arterielle Portchemotherapie nach Resektion colorectaler Lebermetastasen

Riesener

Winkeltau

Kasperk

et al. 1998

Chirurg

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Between 1986 and 1995 we performed radical hepatic resections (R0 resections) in 109 patients with hepatic metastases following colorectal carcinoma. In 50 patients a hepatic arterial port device was implanted for adjuvant regional chemotherapy (HAI). Mitomycin C, 5-fluorouracil, and since 1993 folinic acid have been administered during 6 monthly repeated courses. In 9 patients, the treatment had to be withdrawn because of complications. The remaining 59 patients were not treated. In 73% of the patients after port implantation mostly minor complications occurred during chemotherapy. Our results confirmed a markedly increased survival rate during the first 3 postoperative years, followed by a prolongation of median survival time of treated patients compared to untreated patients. Nevertheless, the observed differences of median survival were not statistically different. In contrast, the 5-year survival rates of both groups were not different. The frequency, localization, and resectability of recurrences were not influenced by adjuvant chemotherapy. However, the lengthening of mean survival time in the treated group might reflect a delay in the occurrence of early recurrences. In conclusion, adjuvant hepatic arterial chemotherapy following resection of colorectal hepatic metastases might be able to prolong the time until recurrence, but does not help to avoiding it. Therefore, it did not increase the rate of cure following R0 resections of colorectal hepatic metastases in our series. Taking into account the high rate of local complications of the port systems in our series, angiographic controls are strongly recommended prior to each chemotherapeutic cycle.

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