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DOI: 10.1055/s-2004-832311
© Georg Thieme Verlag Stuttgart · New York
Stellenwert der radiologischen Bildgebung vor der Resektion von Lebermetastasen aus chirurgischer Sicht unter Berücksichtigung der Kosteneffizienz
Impact and Cost-effectiveness of Radiologic Imaging Before Liver ResectionPublication History
Publication Date:
29 September 2004 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200405/lookinside/thumbnails/10.1055-s-2004-832311-1.jpg)
Zusammenfassung
Die Resektion von Lebermetastasen stellt einen potenziell kurativen Therapieansatz dar, wenn eine R0-Resektion erreicht werden kann. Dabei hat die bildgebende Diagnostik zum Ziel, die Patienten zu identifizieren, die von einer Resektion profitieren werden und unnötige Laparotomien bei inoperablen Befunden und die dadurch entstehenden Kosten zu reduzieren.
Es wurden retrospektiv die Datensätze von 58 Patienten ausgewertet, deren Lebermetastasen im CT oder MRT als resektabel eingestuft wurden. Davon waren 37 (63,7 %) resektabel, ohne dass sich intraoperativ neue Befunde ergaben. In 5 Fällen (8,6 %) lag nach Erhalt der Histologie eine R1-Situation vor. In 16 Fällen (27,6 %) ergaben sich intraoperativ neue Befunde, 3 davon konnten dennoch R0 reseziert werden.
Eine erweiterte präoperative Diagnostik durch SPIO-MRT zur Klärung der lokalen Operabilität und PET zum Ausschluss weiterer Tumormanifestationen ist zwar teuer, aber bereits kosteneffizient, wenn bei 15,5 % der Patienten eine onkologisch nicht sinnvolle und für den Patienten belastende Operation vermieden werden kann.
Abstract
Surgical resection of liver metastases provides the chance for cure or long-term survival in selected patients. The aim of preoperative radiologic imaging is to select those patients that will benefit from surgical resection and avoid the costs for unnecessary laparotomies.
In this retrospective analysis charts of 58 patients with liver metastases that were resectable on CT or MRI imaging were reviewed. 37 patients (63.7 %) were resectable without unexpected findings intraoperatively. In 5 cases (8.6 %) histologic findings showed R1 resection. Unknown tumor manifestations were found in 16 patients (27.6 %), 3 could nevertheless be resected.
Extended preoperative imaging with SPIO-MRI for local resectability and PET scan for extrahepatic tumor manifestations is expensive, but if only in 15.5 % of the patients unnecessary laparotomy can be avoided by extended imaging this would be cost effective.
Schlüsselwörter
Lebermetastasen - Bildgebung - Kosteneffizienz
Key words
Liver metastases - imaging - cost-effectiveness
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Dr. Sonja Pepperl
Klinik für Allgemein- und Gefäßchirurgie der Johann Wolfgang Goethe-Universität
Theodor-Stern-Kai 7
60590 Frankfurt am Main
Phone: 0 69-63 01-52 51
Fax: 0 69-63 01-74 52
Email: sonja.pepperl@kgu.de