Advertisement

Rolle des Radiologen in der Chirurgie kolorektaler Lebermetastasen

Was soll weg und was muss übrig bleiben
  • J. Strohäker
  • A. Königsrainer
  • S. NadalinEmail author
Leitthema
  • 23 Downloads

Zusammenfassung

Hintergrund

Die radikale chirurgische Behandlung kolorektaler Lebermetastasen ist die einzige kurative Therapieoption für betroffene Patienten.

Fragestellung

Interaktionsstellen zwischen Radiologie und Chirurgie in der Planung und Durchführung (komplexer) Leberresektionen werden zusammengefasst.

Ergebnisse

In der Betreuung von Patienten mit kolorektalen Lebermetastasen ergeben sich viele Interaktionspunkte zwischen Radiologie und Chirurgie. Die Radiologie liefert die bildgebende Grundlage der Metastasenlokalisation, Gefäßbezüge sowie die Beurteilung von Leberqualität und Leberfunktion. Perioperativ ermöglichen Interventionen und Ablationen die Behandlung von Komplikationen und nichtchirurgisch entfernbarer Metastasen.

Schlussfolgerung

Die komplexe Leberresektion ist nur nach sorgfältiger Planung und durch interdisziplinäre Betreuung durch Chirurgen, Radiologen und assoziierte Fachrichtungen möglich und erfolgversprechend.

Schlüsselwörter

Kolorektale Lebermetastasen Leberresektion Leberanatomie Leberfunktion Leberdiagnostik 

Abkürzungen

AFLD

Alkoholische Fettlebererkrankung

ALPPS

„Associating liver partition and portal vein ligation for two-staged hepatectomy“

CASH

Chemotherapie-induzierte Steatohepatitis

CASP

Computer-assistierte chirurgische Planung

CT

Computertomographie

FLR

„Future liver remnant“ (Restleber)

FLR/TLV

„Future liver remnant to total liver volume“

MRT

Magnetresonanztomographie

NAFLD

Nichtalkoholische Fettlebererkrankung

NASH

Nichtalkoholische Steatohepatitis

PHLF

„Post hepatectomy liver failure“

PTCD

Perkutane transhepatische Gallengangdrainage

PVE

Pfortaderembolisation

RVBWR

„Residual volume to body weight ratio“

Role of the radiologist in surgery of colorectal liver metastases

What should be removed and what must remain

Abstract

Background

The radical resection of colorectal liver metastases is the only curative option for affected patients. If properly performed, surgery provides the chance of long-term tumor-free survival.

Objective

Summary of the critical interaction points between radiology and surgery in the planning and performance of (complex) liver resections.

Results

There are many interaction points between radiology and surgery in the treatment of patients with colorectal liver metastases. Radiology supports surgery by providing detailed information of the localization of metastases, information on liver inflow and outflow as well as basic information on liver quality and function. Perioperatively, it provides interventional treatment options for postoperative complications as well as ablation of non-resectable metastases.

Conclusion

Complex liver resections can only be performed properly and successfully after thorough planning by an interdisciplinary board of surgeons, radiologists and associated disciplines.

Keywords

Colorectal liver metastasis Liver anatomy Liver quality Liver imaging Liver resection 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Strohäker, A. Königsrainer und S. Nadalin geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Adam R, De Gramont A, Figueras J, Guthrie A, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Tabernero J, Teh C, Van Cutsem E (2012) The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist 17:1225–1239CrossRefGoogle Scholar
  2. 2.
    Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Teh C, Tejpar S, Van Cutsem E, Vauthey JN, Pahlman L (2015) Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 41:729–741CrossRefGoogle Scholar
  3. 3.
    Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785CrossRefGoogle Scholar
  4. 4.
    Beckers RCJ, Lambregts DMJ, Lahaye MJ, Rao SX, Kleinen K, Grootscholten C, Beets GL, Beets-Tan RGH, Maas M (2018) Advanced imaging to predict response to chemotherapy in colorectal liver metastases—a systematic review. HPB (Oxford) 20:120–127CrossRefGoogle Scholar
  5. 5.
    Bonanni L, de’Liguori Carino N, Deshpande R, Ammori BJ, Sherlock DJ, Valle JW, Tam E, O’Reilly DA (2014) A comparison of diagnostic imaging modalities for colorectal liver metastases. Eur J Surg Oncol 40:545–550CrossRefGoogle Scholar
  6. 6.
    Capobianco I, Strohaker J, Penna DA, Nadalin S, Konigsrainer A (2019) Preconditioning of the liver. Chirurg 90(7):542–547CrossRefGoogle Scholar
  7. 7.
    Cassinotto C, Lapuyade B, Mouries A, Hiriart JB, Vergniol J, Gaye D, Castain C, Le Bail B, Chermak F, Foucher J, Laurent F, Montaudon M, De Ledinghen V (2014) Non-invasive assessment of liver fibrosis with impulse elastography: comparison of supersonic shear imaging with ARFI and FibroScan(R). J Hepatol 61:550–557CrossRefGoogle Scholar
  8. 8.
    Charlton MR, Burns JM, Pedersen RA, Watt KD, Heimbach JK, Dierkhising RA (2011) Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Baillieres Clin Gastroenterol 141:1249–1253Google Scholar
  9. 9.
    Cieslak KP, Bennink RJ, de Graaf W, van Lienden KP, Besselink MG, Busch OR, Gouma DJ, van Gulik TM (2016) Measurement of liver function using hepatobiliary scintigraphy improves risk assessment in patients undergoing major liver resection. HPB (Oxford) 18:773–780CrossRefGoogle Scholar
  10. 10.
    Fazakas J, Mandli T, Ther G, Arkossy M, Pap S, Fule B, Nemeth E, Toth S, Jaray J (2006) Evaluation of liver function for hepatic resection. Transplant Proc 38:798–800CrossRefGoogle Scholar
  11. 11.
    Ferrero A, Vigano L, Polastri R, Muratore A, Eminefendic H, Regge D, Capussotti L (2007) Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg 31:1643–1651CrossRefGoogle Scholar
  12. 12.
    Golriz M, Majlesara A, El Sakka S, Ashrafi M, Arwin J, Fard N, Raisi H, Edalatpour A, Mehrabi A (2016) Small for Size and Flow (SFSF) syndrome: an alternative description for posthepatectomy liver failure. Clin Res Hepatol Gastroenterol 40:267–275CrossRefGoogle Scholar
  13. 13.
    Guiu B, Chevallier P, Denys A, Delhom E, Pierredon-Foulongne MA, Rouanet P, Fabre JM, Quenet F, Herrero A, Panaro F, Baudin G, Ramos J (2016) Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol 26:4259–4267CrossRefGoogle Scholar
  14. 14.
    Imamura H, Sano K, Sugawara Y, Kokudo N, Makuuchi M (2005) Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg 12:16–22CrossRefGoogle Scholar
  15. 15.
    Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P (2004) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240:1037–1049 (discussion 1049–1051)CrossRefGoogle Scholar
  16. 16.
    Jung EM, Clevert DA (2018) Contrast-enhanced ultrasound (CEUS) and image fusion for procedures of liver interventions. Radiologe 58:538–544CrossRefGoogle Scholar
  17. 17.
    Jung EM, Clevert DA (2015) Possibilities of sonographic image fusion: current developments. Radiologe 55:937–948CrossRefGoogle Scholar
  18. 18.
    Jung EM, Ross CJ, Rennert J, Scherer MN, Farkas S, von Breitenbuch P, Schnitzbauer AA, Piso P, Lamby P, Menzel C, Schreyer AG, Feuerbach S, Schlitt HJ, Loss M (2010) Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: first results. Clin Hemorheol Microcirc 46:89–99PubMedGoogle Scholar
  19. 19.
    Kishi Y, Madoff DC, Abdalla EK, Palavecino M, Ribero D, Chun YS, Vauthey JN (2008) Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery 144:744–751CrossRefGoogle Scholar
  20. 20.
    Lang H, Radtke A, Hindennach M, Schroeder T, Fruhauf NR, Malago M, Bourquain H, Peitgen HO, Oldhafer KJ, Broelsch CE (2005) Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection. Arch Surg 140:629–638 (discussion 638)CrossRefGoogle Scholar
  21. 21.
    Le Roy B, Perrey A, Fontarensky M, Gagniere J, Abergel A, Pereira B, Lambert C, Boyer L, Pezet D, Chabrot P, Buc E (2017) Combined preoperative portal and hepatic vein embolization (Biembolization) to improve liver regeneration before major liver resection: a preliminary report. World J Surg 41:1848–1856CrossRefGoogle Scholar
  22. 22.
    Lee SS, Park SH, Kim HJ, Kim SY, Kim MY, Kim DY, Suh DJ, Kim KM, Bae MH, Lee JY, Lee SG, Yu ES (2010) Non-invasive assessment of hepatic steatosis: prospective comparison of the accuracy of imaging examinations. J Hepatol 52:579–585CrossRefGoogle Scholar
  23. 23.
    Liu H, Zhu S (2009) Present status and future perspectives of preoperative portal vein embolization. Am J Surg 197:686–690CrossRefGoogle Scholar
  24. 24.
    Majno P, Mentha G, Toso C, Morel P, Peitgen HO, Fasel JH (2014) Anatomy of the liver: an outline with three levels of complexity—a further step towards tailored territorial liver resections. J Hepatol 60:654–662CrossRefGoogle Scholar
  25. 25.
    Mangold S, Bretschneider C, Fenchel M, Seeger A, Kramer U, Klumpp B, Nadalin S, Konigsrainer A, Claussen CD, Miller S (2012) MRI for evaluation of potential living liver donors: a new approach including contrast-enhanced magnetic resonance cholangiography. Abdom Imaging 37:244–251CrossRefGoogle Scholar
  26. 26.
    Nadalin S, Capobianco I, Konigsrainer A (2015) Vascular management in anatomical liver resection. Chirurg 86:121–124CrossRefGoogle Scholar
  27. 27.
    Nilsson H, Blomqvist L, Douglas L, Nordell A, Jacobsson H, Hagen K, Bergquist A, Jonas E (2014) Dynamic gadoxetate-enhanced MRI for the assessment of total and segmental liver function and volume in primary sclerosing cholangitis. J Magn Reson Imaging 39:879–886CrossRefGoogle Scholar
  28. 28.
    Nilsson H, Blomqvist L, Douglas L, Nordell A, Janczewska I, Naslund E, Jonas E (2013) Gd-EOB-DTPA-enhanced MRI for the assessment of liver function and volume in liver cirrhosis. Br J Radiol 86:20120653CrossRefGoogle Scholar
  29. 29.
    Pawlik TM, Abdalla EK, Ellis LM, Vauthey JN, Curley SA (2006) Debunking dogma: surgery for four or more colorectal liver metastases is justified. J Gastrointest Surg 10:240–248CrossRefGoogle Scholar
  30. 30.
    Pawlik TM, Schulick RD, Choti MA (2008) Expanding criteria for resectability of colorectal liver metastases. Oncologist 13:51–64CrossRefGoogle Scholar
  31. 31.
    Pomposelli JJ, Tongyoo A, Wald C, Pomfret EA (2012) Variability of standard liver volume estimation versus software-assisted total liver volume measurement. Liver Transpl 18:1083–1092CrossRefGoogle Scholar
  32. 32.
    Radtke A, Nadalin S, Sotiropoulos GC, Molmenti EP, Schroeder T, Schenk A, Frilling A, Saner FH, Peitgen HO, Broelsch CE, Malago M (2006) Parenchyma transection in adult live donor liver transplantation: the virtual dilemma of “where to cut”. Experience based on virtual 3‑dimensional computed tomography imaging reconstructions. Hepatogastroenterology 53:811–815PubMedGoogle Scholar
  33. 33.
    Radtke A, Sgourakis G, Sotiropoulos GC, Molmenti EP, Saner FH, Timm S, Malago M, Lang H (2009) Territorial belonging of the middle hepatic vein in living liver donor candidates evaluated by three-dimensional computed tomographic reconstruction and virtual liver resection. Br J Surg 96:206–213CrossRefGoogle Scholar
  34. 34.
    Radtke A, Sotiropoulos GC, Molmenti EP, Schroeder T, Peitgen HO, Frilling A, Broering DC, Broelsch CE, Malago M (2010) Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8‑year period. Ann Surg 252:876–883CrossRefGoogle Scholar
  35. 35.
    Radtke A, Sotiropoulos GC, Nadalin S, Molmenti EP, Schroeder T, Lang H, Saner F, Valentin-Gamazo C, Frilling A, Schenk A, Broelsch CE, Malago M (2007) Preoperative volume prediction in adult living donor liver transplantation: how much can we rely on it? Am J Transplant 7:672–679CrossRefGoogle Scholar
  36. 36.
    Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Buchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724CrossRefGoogle Scholar
  37. 37.
    Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, Fichtner-Feigl S, Lorf T, Goralcyk A, Horbelt R, Kroemer A, Loss M, Rummele P, Scherer MN, Padberg W, Konigsrainer A, Lang H, Obed A, Schlitt HJ (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2‑staged extended right hepatic resection in small-for-size settings. Ann Surg 255:405–414CrossRefGoogle Scholar
  38. 38.
    Sotiropoulos GC, Saner FH, Molmenti EP, Radtke A, Timm S, Baba HA, Paul A, Lang H (2009) Unexpected liver failure after right hemihepatectomy for colorectal liver metastasis due to chemotherapy-associated steato-hepatitis: time for routine preoperative liver biopsy? Int J Colorectal Dis 24:241CrossRefGoogle Scholar
  39. 39.
    Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y (2018) Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 55:330–379CrossRefGoogle Scholar
  40. 40.
    Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P (2010) The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 12:139–146CrossRefGoogle Scholar
  41. 41.
    Stockmann M, Lock JF, Riecke B, Heyne K, Martus P, Fricke M, Lehmann S, Niehues SM, Schwabe M, Lemke AJ, Neuhaus P (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 250:119–125CrossRefGoogle Scholar
  42. 42.
    Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW (2000) The brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339CrossRefGoogle Scholar
  43. 43.
    Suzuki K, Epstein ML, Kohlbrenner R, Garg S, Hori M, Oto A, Baron RL (2011) Quantitative radiology: automated CT liver volumetry compared with interactive volumetry and manual volumetry. Ajr Am J Roentgenol 197:W706–712CrossRefGoogle Scholar
  44. 44.
    Tomassini F, D’Asseler Y, Giglio MC, Lecluyse C, Lambert B, Sainz-Barriga M, Van Dorpe J, Hoorens A, Geboes K, Troisi RI (2018) Hemodynamic changes in ALPPS influence liver regeneration and function: results from a prospective study. HPB (Oxford) 21(5):557–565CrossRefGoogle Scholar
  45. 45.
    Torzilli G, Vigano L, Gatti A, Costa G, Cimino M, Procopio F, Donadon M, Del Fabbro D (2017) Twelve-year experience of “radical but conservative” liver surgery for colorectal metastases: impact on surgical practice and oncologic efficacy. HPB (Oxford) 19:775–784CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral und TransplantationschirurgieUniversitätsklinikum TübingenTübingenDeutschland

Personalised recommendations