Operationsindikation bei Lebermetastasen nichtkolorektaler Karzinome

Sturm, J.; Raute, M.; Trede, M.

doi:10.1007/978-3-642-76425-7_35

Cited by 6 publications

(3 citation statements)

References 9 publications

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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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“…Bei Patienten mit nicht colorectalen und nicht neuroendokrinen Lebermetastasen sollte die Indikation zur Leberresektion sehr zurückhaltend und Einzelfallbezogen getroffen werden. Resektionszahl Überlebende (Jahre) Ramming 1977 [46] 8/123 2 (5) Foster 1981 [18] 3/335 2 (2) Thompson 1983 [62] 1/138 1 (5) Stehlin 1988 [57] 4/111 1 (5) Iwatsuki 1989 [27] 3/411 0 (5) Sturm 1991 [60] 2/34 1 (5) Stief 1997 [58] 17/539 ± Gesamt 38/1691 ±…”

Section: Fazitunclassified

Prinzipien der kurativen Lebermetastasenresektion

Schlag

Benhidjeb

Kilpert

1999

Chirurg

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For patients with liver metastases, surgery currently represents the only possibility for cure, with a mean 5-year survival rate of 25-35%. Due to refinement in operative and anesthetic techniques and improved critical care with decreased morbidity (< 25%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. Surgery has repeatedly achieved long-term disease-free survival in 20-25% of patients. However, only 10-25% of patients with colorectal liver metastases can undergo potentially curative liver resection. Therefore, accurate staging plays a pivotal role in selecting patients who would benefit from surgery. For metastatic colorectal cancer, resection offers the only potential for cure. For symptomatic neuroendocrine tumors, hepatic resection offers long-term palliation in many cases and cure in some. The role of hepatic resection for noncolorectal and nonneuroendocrine metastases, however, is less well defined. Recurrence of hepatic metastases after seemingly curative resection is observed in about 40-60% of the cases. Only 20-35% of these recurrent metastases appear to be resectable, resulting in an overall 3-year survival rate of about 30%. The morbidity and mortality from repeat hepatectomy is similar to that of first hepatic resection. All results together demonstrate that resection and re-resection of liver metastases can provide long-term survival rates and can be beneficial in a carefully selected group of patients without extrahepatic disease.

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“…Grunds~itzlich besteht Obereinstimmung, dal3 nichtkolorektale Tumoren ein andersartiges Metastasierungsprofil aufweisen als kolorektale Primfirtumoren und somit getrennt zu betrachten sind. Eine strenge pr~i-und intraoperative Selektionierung ist die Voraussetzung for eine langfristig erfolgreiche Metastasenresektion [28,45,50], wobei vorl~iufig dieselben Resektionskriterien wie beim kolorektalen Karzinom zur Anwendung kommen sollten. Dies gilt selbst for intestinale Tumoren mit portalven6sem Abstrom wie beispielsweise dem Magenkarzinom und rechtfertigt die isolierte Betrachtung des kolorektalen Karzinoms bei der Beurteilung von Erfolgen der Metastasentherapie.…”

Section: Alter Geschlecm Grunderkrankungunclassified

Chirurgische therapie von lebermetastasen therapieverfahren, ergebnisse und prognosefaktoren

Riesener

Winkeltau

Klemm

et al. 1994

Langenbecks Arch Chir

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In a period of 7 years, 151 patients were treated by resection and/or regional chemotherapy after liver metastases from various primary tumours. The subgroup of patients with colorectal liver metastases was evaluated separately from the heterogeneous group with any other primaries. Radical resection of colorectal liver metastases was followed by a 5-year survival of 17%. The time from resection of the primary to development of the metastatic lesions was shown by univariate and multivariate analysis to be the most important prognostic factor. Adjuvant regional chemotherapy failed to improve outcome after curative resection of liver metastases. Neither palliative regional chemotherapy in cases of diffuse hepatic metastases nor the combination of palliative resection with regional or systemic chemotherapy significantly prolonged survival.

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Operationsindikation bei Lebermetastasen nichtkolorektaler Karzinome

Cited by 6 publications

References 9 publications

Ergebnisse der Resektion nichtcolorectaler nichtneuroendokriner Lebermetastasen

Ergebnisse der Resektion nichtcolorectaler nichtneuroendokriner Lebermetastasen

Prinzipien der kurativen Lebermetastasenresektion

Chirurgische therapie von lebermetastasen therapieverfahren, ergebnisse und prognosefaktoren

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