Interventionelle, laparoskopische und offen operative Radiofrequenztherapie maligner Leberläsionen

Zusammenfassung

Die wachsende klinische Bedeutung der Radiofrequenz induzierten Ablation an der Leber wird begleitet von einer schnell zunehmenden Zahl an Publikationen. Im experimentellen Bereich liegt ein besonderes Augenmerk darauf Faktoren zu definieren, die die Variabilität der Nekroseausdehnung reduzieren. Das Pringle-Manöver steht hier für den Chirurgen an erster Stelle. Die Lokalrezidivrate steigt in großen Einzelserien und einer Metaanalyse bei einem Tumordurchmesser > 3 cm drastisch an. Ein offen chirurgischer Zugang ist mit einer signifikant geringeren Lokalrezidivrate nach RFA verbunden. Gallenwegsschäden und intrahepatische Abszesse sind die häufigsten Komplikationen. Die intraduktale Gallenwegskühlung vermindert experimentell und klinisch die Häufigkeit dieser Komplikationen. Die Indikation zur RFA ist bei hepatozellulären Karzinomen durch 3 prospektive, randomisierte Studien gesichert. Für die Indikation bei kolorektalen Metastasen liegen Einzelserien bei Patienten mit multiplen Metastasen und einem 3-Jahres-Überleben > 35 % vor. In zukünftigen multimodalen Therapiekonzepten wird die RFA aufgrund der günstigen Kosten / Nutzen-Relation einen im Detail noch zu definierenden Platz einnehmen.

Abstract

The growing clinical impact of radiofrequency ablation of liver lesions is reflected by a rapidly increasing number of published papers. Experimental work focuses on factors that reduce the variability of the ablation zone. The Pringle-maneuver plays a key role in this question from a surgeon's perspective. Large single center studies and a meta-analysis show a sharp rise in the rate of local recurrences for tumors larger 3 cm. An open surgical approach is significantly correlated to a low local recurrence rate. Bile duct lesions and intrahepatic abscesses are the most frequent complications. Intraductal bile duct cooling can prevent these complications. Three prospective randomized trials support the use of RFA for small hepatocellular carcinoma. The use of RFA in patients with multiple colorectal metastases is supported by single center studies showing a 3 year survival of > 35 %. The favourable cost / benefit ratio will make RFA a part of future multimodal cancer therapy concepts.

Schlüsselwörter

Lebermetastase - Leberzellkarzinom - RFA - Zugang - Patientenüberleben

Key words

liver metastasis - primary liver cancer - RFA - approach - outcome

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