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.
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“
Literatur
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 17:1225–1239
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 41:729–741
Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785
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) 20:120–127
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 40:545–550
Capobianco I, Strohaker J, Penna DA, Nadalin S, Konigsrainer A (2019) Preconditioning of the liver. Chirurg 90(7):542–547
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 61:550–557
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 141:1249–1253
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) 18:773–780
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 38:798–800
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 31:1643–1651
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 40:267–275
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 26:4259–4267
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 12:16–22
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)
Jung EM, Clevert DA (2018) Contrast-enhanced ultrasound (CEUS) and image fusion for procedures of liver interventions. Radiologe 58:538–544
Jung EM, Clevert DA (2015) Possibilities of sonographic image fusion: current developments. Radiologe 55:937–948
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 46:89–99
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 144:744–751
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)
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 41:1848–1856
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 52:579–585
Liu H, Zhu S (2009) Present status and future perspectives of preoperative portal vein embolization. Am J Surg 197:686–690
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 60:654–662
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 37:244–251
Nadalin S, Capobianco I, Konigsrainer A (2015) Vascular management in anatomical liver resection. Chirurg 86:121–124
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 39:879–886
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 86:20120653
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 10:240–248
Pawlik TM, Schulick RD, Choti MA (2008) Expanding criteria for resectability of colorectal liver metastases. Oncologist 13:51–64
Pomposelli JJ, Tongyoo A, Wald C, Pomfret EA (2012) Variability of standard liver volume estimation versus software-assisted total liver volume measurement. Liver Transpl 18:1083–1092
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 53:811–815
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 96:206–213
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 252:876–883
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 7:672–679
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 149:713–724
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 255:405–414
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 24:241
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 55:330–379
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) 12:139–146
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 250:119–125
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 2:333–339
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:W706–712
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):557–565
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) 19:775–784
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J. Strohäker, A. Königsrainer und S. Nadalin geben an, dass kein Interessenkonflikt besteht.
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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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DOI: https://doi.org/10.1007/s00117-019-0577-7