Viszeralchirurgie 2004; 39(2): 104-108
DOI: 10.1055/s-2004-818766
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Ergebnisse nach Resektion nichtkolorektaler, nichtneuroendokriner Lebermetastasen

Results of Hepatic Resection for Non-Colorectal, Non-Neuroendocrine Liver MetastasesF. Lehner1 , H. Bektas1 , T. Becker1 , J. Klempnauer1
  • 1Klinik für Viszeral- und Transplantationschirurgie
Further Information

Publication History

Publication Date:
21 April 2004 (online)

Zusammenfassung

Die Behandlung von Lebermetastasen stellt eine elementare Aufgabe der Chirurgie dar. Während die Leberresektion von kolorektalen als anerkanntes Therapieverfahren gilt, ist die Datenlage bezüglich der nichtkolorektalen, nichtneuroendokrinen Lebermetastasen schwer zu interpretieren.
Anhand eines Literaturüberblickes und der in Klinik für Viszeral- und Transplantationschirurgie der Medizinischen Hochschule Hannover im Zeitraum von Januar 1994 bis Dezember 2003 durchgeführten Leberresektionen bei nichtkolorektalen, nichtneuroendokrinen Lebermetastasen werden Ergebnisse und Einflussfaktoren auf das Patienenüberleben analysiert.
Die Analyse zeigt, dass Leberresektionen auch bei nichtkolorektalen, nichtneuroendorkinen Lebermetastasen mit einem niedrigen operativen Risiko durchgeführt werden können. Unter Beachtung strenger Indikationskriterien, wie Möglichkeit der R0-Resektion, keine extrahepatische Tumormanifestation, biologischer und funktioneller Operabilität und unter Einbindung der Leberchirurgie in ein multimodales Therapiekonzept stellt die Leberresektion in individuellen Fällen eine wichtige Therapieoption dar.

Abstract

Major hepatic surgery can be performed safely and resection for metastatic disease is increasingly carried out. However, the role of liver resection for hepatic metastases from non-colorectal, non-neuroendocrine cancers remains controversial.

The aim of our study was to evaluate the centre experience with hepatic surgery for non-colorectal non-neuroendocrine liver metastases and to compare these results to the current literature.

Records of 217 patients who underwent liver resection for metastatic non-colorectal, non-neuroendocrine cancer form January 1994 to December 2003 were reviewed. Survival after liver resection in this cohort of patients is reported and factors predictive of survival are analyzed.

Our data show that liver resection for non-colorectal, non-neuroendocrine metastases can be performed with low morbidity and mortality rates similar to colorectal metastases. Primary tumour type, disease-free interval and curative resection predict those patients who benefit from hepatic resection. Therefore the indication for liver resection is one therapeutic option in a multimodal treatment concept and should be considered carefully in every single case.

Literatur

  • 1 Liu L X, Zhang W H, Jiang H C. Current treatment for liver metastases from colorectal cancer.  World J Gastroenterol. 2003;  9 193-200
  • 2 Junginger T, Kneist W, Seifert J K. [Surgical treatment of colorectal liver metastases].  Zentralbl Chir. 2003;  128 911-919
  • 3 Seifert J K, Bottger T C, Weigel T F, Gonner U, Junginger T. Prognostic factors following liver resection for hepatic metastases from colorectal cancer.  Hepatogastroenterology. 2000;  47 239-246
  • 4 Sarmiento J M, Que F G. Hepatic surgery for metastases from neuroendocrine tumors.  Surg Oncol Clin N Am. 2003;  12 231-242
  • 5 Nave H, Mossinger E, Feist H, Lang H, Raab H. Surgery as primary treatment in patients with liver metastases from carcinoid tumors: a retrospective, unicentric study over 13 years.  Surgery. 2001;  129 170-175
  • 6 Ott R, Wein A, Hohenberger W. [Liver metastases - primary or multimodal therapy?].  Chirurg. 2001;  72 887-897
  • 7 Sugarbaker P H. Repeat hepatectomy for colorectal metastases.  J Hepatobiliary Pancreat Surg. 1999;  6 30-38
  • 8 Fong Y. Surgical therapy of hepatic colorectal metastasis.  CA Cancer J Clin. 1999;  49 231-255
  • 9 Bakalakos E A, Kim J A, Young D C, Martin E W. Determinants of survival following hepatic resection for metastatic colorectal cancer.  World J Surg. 1998;  22 399-404
  • 10 Jarnagin W R, Bodniewicz J, Dougherty E, Conlon K, Blumgart L H, Fong Y. A prospective analysis of staging laparoscopy in patients with primary and secondary hepatobiliary malignancies.  J Gastrointest Surg. 2000;  4 34-43
  • 11 Pietra N, Sarli L, Costi R, Ouchemi C, Grattarola M, Peracchia A. Role of follow-up in management of local recurrences of colorectal cancer: a prospective, randomized study.  Dis Colon Rectum. 1998;  41 1127-1133
  • 12 Elias D, Cavalcanti de Albuquerque A, Eggenspieler P. et al . Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients.  J Am Coll Surg. 1998;  187 487-493
  • 13 Miyazaki M, Itoh H, Nakagawa K. et al . Hepatic resection of liver metastases from gastric carcinoma.  Am J Gastroenterol. 1997;  92 490-493
  • 14 Maksan S M, Lehnert T, Bastert G, Herfarth C. Curative liver resection for metastatic breast cancer.  Eur J Surg Oncol. 2000;  26 209-212
  • 15 Lorenz M, Wiesner J, Staib-Sebler E, Encke A. [Regional therapy breast cancer liver metastases].  Zentralbl Chir. 1995;  120 786-790
  • 16 Meijer S, Peretz T, Gaynor J J, Tan C, Hajdu S I, Brennan M F. Primary colorectal sarcoma. A retrospective review and prognostic factor study of 50 consecutive patients.  Arch Surg. 1990;  125 1163-1168
  • 17 Hafner G H, Rao U, Karakousis C P. Liver metastases from soft tissue sarcomas.  J Surg Oncol. 1995;  58 12-16
  • 18 Jaques D P, Coit D G, Casper E S, Brennan M F. Hepatic metastases from soft-tissue sarcoma.  Ann Surg. 1995;  221 392-397
  • 19 Lorenz M, Staib-Sebler E, Gog C, Waldeyer M, Encke A. Adjuvante und neoadjuvante Therapie sekundärer Lebertumoren.  Chir Gastroenterol. 1997;  13 22
  • 20 Schlag P M, Benhidjeb T, Kilpert B. [Principles of curative resection of liver metastases].  Chirurg. 1999;  70 123-132
  • 21 Ochiai T, Sasako M, Mizuno S. et al . Hepatic resection for metastatic tumours from gastric cancer: analysis of prognostic factors.  Br J Surg. 1994;  81 1175-1178
  • 22 Taniguchi H, Takahashi T, Sawai K. et al . Comparison in survival between hepatic metastases of gastric and colorectal cancers.  Hepatogastroenterology. 1997;  44 897-900
  • 23 Saitoh H, Yoshida K, Uchijima Y, Kobayashi N, Suwata J, Nakame Y. Possible metastatic routes via portacaval shunts in renal adenocarcinoma with liver metastasis.  Urology. 1991;  37 598-601
  • 24 Wyld L, Gutteridge E, Pinder S E. et al . Prognostic factors for patients with hepatic metastases from breast cancer.  Br J Cancer. 2003;  89 284-290
  • 25 Schneebaum S, Walker M J, Young D, Farrar W B, Minton J P. The regional treatment of liver metastases from breast cancer.  J Surg Oncol. 1994;  55 26-31
  • 26 Hoe A L, Royle G T, Taylor I. Breast liver metastases - incidence, diagnosis and outcome.  J R Soc Med. 1991;  84 714-716
  • 27 Ng E H, Pollock R E, Munsell M F, Atkinson E N, Romsdahl M M. Prognostic factors influencing survival in gastrointestinal leiomyosarcomas. Implications for surgical management and staging.  Ann Surg. 1992;  215 68-77
  • 28 Saito A, Korenaga D, Sakaguchi Y, Ohno S, Ichiyoshi Y, Sugimachi K. Surgical treatment for gastric carcinomas with concomitant hepatic metastasis.  Hepatogastroenterology. 1996;  43 560-564
  • 29 Zacherl J, Zacherl M, Scheuba C. et al . Analysis of hepatic resection of metastasis originating from gastric adenocarcinoma.  J Gastrointest Surg. 2002;  6 682-689
  • 30 Klempnauer J, Ridder G J, Piso P, Pichlmayr R. [Is liver resection in metastases of exocrine pancreatic carcinoma justified?].  Chirurg. 1996;  67 366-370
  • 31 Takada T, Yasuda H, Amano H, Yoshida M, Uchida T. Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival?.  Hepatogastroenterology. 1997;  44 567-573
  • 32 Lorenz M, Staib-Sebler E, Gog C, Waldeyer M, Encke A. Adjuvante und neoadjuvante Therapie sekundärer Lebertumoren.  Chir Gastroenterolol. 1997;  13 22
  • 33 Yoshimoto M, Tada T, Saito M, Takahashi K, Uchida Y, Kasumi F. Surgical treatment of hepatic metastases from breast cancer.  Breast Cancer Res Treat. 2000;  59 177-184
  • 34 Lang H, Nussbaum K T, Weimann A, Raab R. [Liver resection for non-colorectal, non-neuroendocrine hepatic metastases].  Chirurg. 1999;  70 439-446

Dr. F. Lehner

Klinik für Viszeral- und Transplantationschirurgie · Medizinische Hochschule Hannover

Carl-Neuberg-Str. 1

30625 Hannover

Phone: 05 11/5 32-65 27

Fax: 05 11/5 32-40 10

Email: Lehner.Frank@mh-hannover.de