Article

Chirurgische und interventionelle Therapiem�glichkeiten bei Fernmetastasen kolorektaler Karzinome

Chirurgische Gastroenterologie (Impact Factor: 0.14). 01/2005; 21. DOI: 10.1159/000085389

ABSTRACT In der Vergangenheit galt das hepatisch oder pulmonal metastasierte kolorektale Karzinom als nicht heilbare Erkrankung. W�hrend der letzten 30 Jahre hat die radikale chirurgische Therapie bei diesen Patienten zu einer signifikanten Prognoseverbesserung mit 5-Jahres-�berlebensraten bis 40% bei geringer perioperativer Mortalit�t und Morbidit�t gef�hrt. Aufgrund der Ausdehnung der Lungen- und Lebermetastasen sowie weiterer Tumormanifestationen kommen aber nur 10-20% aller Patienten f�r eine chirurgische Therapie in Frage. Limitierend f�r die Leberresektion ist meist die anatomische Lage und Ausdehnung der Metastasen mit einem zu kleinen verbleibenden Leberrest. Durch die Tumorverkleinerung mittels pr�operativer Chemotherapie, Induktion der Regeneration des Lebergewebes durch Portalvenenembolisation und die zweizeitige Resektion k�nnen weitere Patienten einer chirurgischen Therapie zugef�hrt werden. Die 5-Jahres-�berlebensrate nach Konditionierung dieser Patienten liegt bei zirka 30%. Prognosefaktoren wie Anzahl der Tumoren, Gr��e der L�sion, CEA-Werte, Tumorstadium des Primarius und Zeitintervall zur Prim�roperation sind mit der Prognose assoziiert und werden kontrovers diskutiert, schlie�en aber ein langfristiges tumorfreies �berleben der Patienten nicht aus. Isolierte Lungenmetastasen liegen nur bei 2-4% der Patienten vor. Die 5-Jahres-Ergebnisse entsprechen bei kurativer Resektion den Ergebnissen nach Leberresektionen. Die Untersuchung der Prognosefaktoren f�r den Verlauf nach Resektion der pulmonalen Metastasen hat gezeigt, dass Heilungen m�glich sind, wenn die Metastasen vollst�ndig entfernt werden k�nnen. F�r kombinierte Lungen- und Lebermetastasen gilt, dass die kurative Resektion aller Tumormanifestationen die Prognose der Patienten verbessert und 5-Jahres-�berlebensraten >20% erreicht werden k�nnen. Lokale ablative Verfahren wie die Radiofrequenzablation sind gut einsetzbar, um kleinere L�sionen im Rahmen ausgedehnter Leberresektionen zu zerst�ren, sind aber hinsichtlich des Langzeit�berlebens und der Lokalrezidivrate der chirurgischen Therapie nicht gleichwertig. Aus diesen Gr�nden sollte bei allen Patienten mit einem metastasiertem Karzinom, bei denen eine kurative Resektion erreicht werden kann, die chirurgische Therapie angestrebt werden.

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