Wann sollte man benigne Lebertumoren chirurgisch behandeln?

Abstract

The authors present their results on the treatment of benign liver tumors. 65 patients were operated upon in the University Hospital in Pil-sen from 2000 until July 2006. Benign liver lesions were rather rare compared to malignant tumours, for which 273 patients were treated within the same period. The most often found benign -lesions were hepatocellular adenoma, focal nodular hyperplasia (FNH) and hemangioma. Sometimes, it was not possible to make a correct diagnosis preoperatively. The surgical procedures used for benign tumours were mostly enucleation and non-anatomic parenchyma-saving resection (55.4 %). Morbidity in this group was 26.5 %, mortality 0 %.

“Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma

“…In addition, diagnostic tools are used increasingly in asymptomatic individuals without defined suspected diagnoses in the setting of general prevention or followup after a history of malignancy [1–4]. Unfortunately, the histological nature of a hepatic tumor is rarely proven by one method of imaging, and even sophisticated technologies some doubt regarding the benign or malign behavior of a tumor remain in 10–40% [5, 6]. These accidentally detected liver tumors without liver-specific symptoms such as cholestasis or portal hypertension have been named “incidentalomas” [4]; the reported incidence of these findings ranges from 10.2 to 52% [7, 8].…”

“…Generally a primarily conservative approach is considered to be the method of first choice in the treatment of proven benign liver tumors [1, 3, 5, 10, 11]. In total for about 5% of newly diagnosed benign liver tumors, surgery is warranted [10].…”

“…This may occur as a free rupture with haemoperitoneum, as prolonged intrahepatic haemorrhage or hemobilia leading to gastrointestinal bleeding, the latter being considerably difficult to diagnose [16, 17]. In spite of the low morbidity and minimal mortality of liver resections in specialized institutions, surgical treatment of benign liver lesion is only justified in the above indications and requires precise criterions [3–5]. …”

“…Surgical therapy can be discussed, especially for large expansive growing FNH nodes [5, 10]. This is especially for women wishing to have children clinically relevant.…”

Intrahepatische Ablation: Radiofrequenzablation versus Elektrochemische Lyse

“…Im Beobachtungszeitraum von 7 Tagen in dieser Arbeit waren bei RFA und ECL keine sekundären negativen Alterationen wie Gefäßstenosierungen, -leckagen, Lungenembolien oder Destruktionen der intrahepatischen Gallenwege nachzuweisen. Während man bei chirurgischer Resektion von einer Morbidität zwischen 20 % und 35 % ausgehen kann[35][36][37], wird in der Literatur die RFA-assoziierte Mortalität mit 0,5-1,4 %, die Morbidität (Majorkomplikationen) immerhin mit 3,2-12,0 % angegeben[38- 40]. Letztere beinhaltet intraabdominelle Blutungen, Leberversagen, peritonitisch-septische Verläufe und Stenosierungen der ableitenden Gallenwege.…”