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Bildgestützte minimal-invasive Chirurgie und andere lokaltherapeutische Verfahren bei primären Lebertumoren

Image-guided, minimally invasive surgery and other local therapeutic procedures for primary liver tumors

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Zusammenfassung

Hintergrund

Die Inzidenz primärer Lebertumoren steigt. Moderne minimal-invasive bildgestützte Verfahren ermöglichen eine Therapie mit kurativem Ansatz.

Untersuchungsziel

Ziel der Arbeit ist es, die Vielzahl der bildgestützten minimal-invasiven Verfahren bezüglich der Evidenz in Bezug auf die lokale Tumorkontrolle und das Gesamtüberleben darzustellen.

Material und Methoden

MEDLINE-Recherche zum Thema hepatozelluläres Karzinom (HCC), minimal-invasive Therapie, lokal ablative Therapie, Therapiestratifizierung, vergleichende Studien.

Ergebnisse

Der Evidenzgrad unterscheidet sich sehr stark in Abhängigkeit von den betrachteten Verfahren. Die besten Daten inklusive prospektiv randomisierter Studien liegen für die Radiofrequenzablation (RFA) des HCC vor. Die RFA ist den anderen ablativen Verfahren bezüglich Tumorkontrolle und Gesamtüberleben überlegen. Im Vergleich zwischen RFA und chirurgischer Resektion liegen randomisierte Studien mit widersprüchlichen Ergebnissen vor. Die Mikrowellenablation und robotische stereotaktische Bestrahlung zeigten in retrospektiven Studien im Vergleich zur RFA und Chirurgie genug Potenzial, um die Techniken in randomisierten Studien zu bestätigen. Für den „high intensity focused ultrasound“ (HIFU) und die irreversible Elektroporation liegen nur anekdotische Daten vor. Die perkutane Ethanolinjektion (PEI), die Kryoablation und die „laser-induced thermal therapy“ (LITT) sind in Studien der RFA unterlegene Techniken.

Schlussfolgerung

Auf dem Boden einer strukturierten radiologischen Bildgebung und Befundung können eine minimal-invasive Resektion und lokal ablative Techniken die Prognose beim HCC auch über das Stadium BCLC 0/A hinaus verbessern.

Abstract

Background

The incidence of primary liver tumors is rising. Modern minimally invasive, image-guided procedures offer a potentially curative therapy option.

Objective

The aim of this study was to evaluate the multitude of image-guided minimally invasive procedures concerning their evidence-based effect on local tumor control and overall survival.

Material and methods

A systematic search of MEDLINE focused on hepatocellular cancer, minimally invasive treatment, local ablative therapy, therapeutic stratification and comparative studies was performed.

Results

The level of evidence varied greatly depending on the procedure used. The highest quality evidence including prospective randomized studies was found for radiofrequency ablation (RFA) of hepatocellular cancer. The RFA is superior with respect to local tumor control and overall survival in comparison to other ablative procedures. Prospective randomized studies comparing surgery and RFA showed diverging and contradictory results. Microwave ablation and robotic stereotactic irradiation showed sufficient potential in retrospective studies in comparison to RFA and surgery in order to confirm the techniques in randomized studies. There is only anecdotal evidence concerning high intensity focused ultrasound (HIFU) and irreversible electroporation. Percutaneous ethanol injection (PEI), cryoablation and laser-induced thermal therapy (LITT) were inferior techniques to RFA in most studies.

Conclusion

Minimally invasive resection and local ablative therapies based on structured imaging and image reporting can improve the prognosis of patients with hepatocellular cancer even in patients that exceed the BCLC 0/A stage.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinik Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland

    D. L. Stippel, R. Wahba & C. J. Bruns

  2. Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Deutschland

    A. Bunck & T. Persigehl

  3. Klinik und Poliklinik für Radioonkologie, Cyberknife- und Strahlentherapie, Uniklinik Köln, Köln, Deutschland

    C. Baues

Authors
  1. D. L. Stippel
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  2. R. Wahba
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  3. C. J. Bruns
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  4. A. Bunck
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  5. C. Baues
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Corresponding author

Correspondence to D. L. Stippel.

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Interessenkonflikt

D.L. Stippel, R. Wahba, C. Bruns, A. Bunck, C. Baues und T. Persigehl geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Stippel, D.L., Wahba, R., Bruns, C.J. et al. Bildgestützte minimal-invasive Chirurgie und andere lokaltherapeutische Verfahren bei primären Lebertumoren. Chirurg 89, 872–879 (2018). https://doi.org/10.1007/s00104-018-0688-0

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