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Rolle des Radiologen in der Chirurgie kolorektaler Lebermetastasen

Was soll weg und was muss übrig bleiben

Role of the radiologist in surgery of colorectal liver metastases

What should be removed and what must remain

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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.

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.

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Abbreviations

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“

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland

    J. Strohäker, A. Königsrainer &  S. Nadalin FEBS

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Correspondence to S. Nadalin FEBS.

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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.

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Strohäker, J., Königsrainer, A. & Nadalin, S. Rolle des Radiologen in der Chirurgie kolorektaler Lebermetastasen. Radiologe 59, 791–798 (2019). https://doi.org/10.1007/s00117-019-0577-7

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