Skip to main content
Erschienen in: World Journal of Surgery 4/2013

01.04.2013

Clinicopathological Features of Recurrence in Patients After 10-year Disease-free Survival Following Curative Hepatic Resection of Hepatocellular Carcinoma

verfasst von: Masaki Kaibori, Shoji Kubo, Hiroaki Nagano, Michihiro Hayashi, Seiji Haji, Takuya Nakai, Morihiko Ishizaki, Kosuke Matsui, Takahiro Uenishi, Shigekazu Takemura, Hiroshi Wada, Shigeru Marubashi, Koji Komeda, Fumitoshi Hirokawa, Yasuyuki Nakata, Kazuhisa Uchiyama, A-Hon Kwon

Erschienen in: World Journal of Surgery | Ausgabe 4/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

The present study aimed to clarify the clinicopathologic features of long-term disease-fee survival after resection of hepatocellular carcinoma (HCC).

Methods

This retrospective study identified 940 patients who underwent curative resection of HCC between 1991 and 2000 at five university hospitals. Seventy-four patients with 10 years of recurrence-free survival were identified and followed up. They were divided into two groups, 60 recurrence-free and 14 with recurrence after a 10-year recurrence-free period.

Results

Overall survival rates of recurrence and non-recurrence groups were 68 and 91 % at 16 years, and 34 and 91 % at 20 years (p = 0.02), respectively. There were five (36 %), and two deaths (3 %), respectively, after 10 recurrence-free years. A second resection for recurrence was performed in four patients (29 %), and mean survival was 15.3 years after the first hepatectomy. Although three patients in the non-recurrence group (5 %) developed esophageal and/or gastric varices, seven patients in the recurrence group (50 %) developed varices during 10 years (p < 0.0001). In multivariate analysis, preoperative and 10-year platelet count was identified as a favorable independent factor for maintained recurrence-free survival after a 10-year recurrence-free period following curative hepatic resection of HCC.

Conclusions

Recurrence of HCC may occur even after a 10-year recurrence-free period. Long-term follow-up after resection of HCC is important, and should be life-long. Patients with higher preoperative and 10-year platelet counts are more likely to have long-term survival after resection. A low platelet count, related to the degree of liver fibrosis, is a risk factor for recurrence and survival of HCC after curative resection.
Literatur
1.
Zurück zum Zitat Bosch X, Ribes J, Borras J (1999) Epidemiology of primary liver cancer. Semin Liver Dis 19:271–285PubMedCrossRef Bosch X, Ribes J, Borras J (1999) Epidemiology of primary liver cancer. Semin Liver Dis 19:271–285PubMedCrossRef
2.
Zurück zum Zitat Taylor-Robinson SD, Foster GR, Arora S et al (1997) Increase in primary liver cancer in the UK 1979–94. Lancet 350:1142–1143PubMedCrossRef Taylor-Robinson SD, Foster GR, Arora S et al (1997) Increase in primary liver cancer in the UK 1979–94. Lancet 350:1142–1143PubMedCrossRef
3.
Zurück zum Zitat EI-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750CrossRef EI-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750CrossRef
4.
Zurück zum Zitat Kotoh K, Sakai H, Sakamoto S et al (1994) The effect of percutaneous ethanol injection therapy on small solitary hepatocellular carcinoma is comparable to that of hepatectomy. Am J Gastroenterol 89:194–198PubMed Kotoh K, Sakai H, Sakamoto S et al (1994) The effect of percutaneous ethanol injection therapy on small solitary hepatocellular carcinoma is comparable to that of hepatectomy. Am J Gastroenterol 89:194–198PubMed
5.
Zurück zum Zitat Seki T, Wakabayashi M, Nakagawa T et al (1994) Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer 74:817–825PubMedCrossRef Seki T, Wakabayashi M, Nakagawa T et al (1994) Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer 74:817–825PubMedCrossRef
6.
Zurück zum Zitat Chen MS, Li JO, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328PubMedCrossRef Chen MS, Li JO, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328PubMedCrossRef
7.
Zurück zum Zitat Tung-Ping Poon R, Fan ST, Wong J (2000) Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 232:10–24PubMedCrossRef Tung-Ping Poon R, Fan ST, Wong J (2000) Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 232:10–24PubMedCrossRef
8.
Zurück zum Zitat Nagasue N, Uchida M, Makino Y et al (1993) Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 105:488–494PubMedCrossRef Nagasue N, Uchida M, Makino Y et al (1993) Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 105:488–494PubMedCrossRef
9.
Zurück zum Zitat Shirabe K, Shimada M, Kajiyama K et al (1998) Clinicopathologic features of patients with hepatocellular carcinoma surviving >10 years after hepatic resection. Cancer 83:2312–2316PubMedCrossRef Shirabe K, Shimada M, Kajiyama K et al (1998) Clinicopathologic features of patients with hepatocellular carcinoma surviving >10 years after hepatic resection. Cancer 83:2312–2316PubMedCrossRef
10.
Zurück zum Zitat Poon RT, Ng IO, Fan ST et al (2001) Clinicopathologic features of long-term survivors and disease-free survivors after resection of hepatotocellular carcinoma: a study of a prospective cohort. J Clin Oncol 19:3037–3044PubMed Poon RT, Ng IO, Fan ST et al (2001) Clinicopathologic features of long-term survivors and disease-free survivors after resection of hepatotocellular carcinoma: a study of a prospective cohort. J Clin Oncol 19:3037–3044PubMed
11.
Zurück zum Zitat Shimada K, Sano T, Sakamoto Y et al (2005) A long-term follow-up and management study of hepatocellular carcinoma patients surviving for 10 years or longer after curative hepatectomy. Cancer 104:1939–1947PubMedCrossRef Shimada K, Sano T, Sakamoto Y et al (2005) A long-term follow-up and management study of hepatocellular carcinoma patients surviving for 10 years or longer after curative hepatectomy. Cancer 104:1939–1947PubMedCrossRef
12.
Zurück zum Zitat Fukuda S, Itamoto T, Amano H et al (2007) Clinicopathologic features of hepatocellular carcinoma patients with compensated cirrhosis surviving more than 10 years after curative hepatectomy. World J Surg 31:345–352PubMedCrossRef Fukuda S, Itamoto T, Amano H et al (2007) Clinicopathologic features of hepatocellular carcinoma patients with compensated cirrhosis surviving more than 10 years after curative hepatectomy. World J Surg 31:345–352PubMedCrossRef
13.
Zurück zum Zitat Strasberg SM, Belghiti J, Clavn P-A et al (2000) The Brisbane 2000 terminology of liver anatomy and resection. Terminology committee of the international hepato-pancreato-biliary association. HPB 2:333–339 Strasberg SM, Belghiti J, Clavn P-A et al (2000) The Brisbane 2000 terminology of liver anatomy and resection. Terminology committee of the international hepato-pancreato-biliary association. HPB 2:333–339
14.
Zurück zum Zitat Couinaud C (ed) (1957) Le Foie: Etudes Anatomiques et Chirurgicale. Masson, Paris Couinaud C (ed) (1957) Le Foie: Etudes Anatomiques et Chirurgicale. Masson, Paris
15.
Zurück zum Zitat Kaibori M, Matsui Y, Hijikawa T et al (2006) Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery 139:385–394PubMedCrossRef Kaibori M, Matsui Y, Hijikawa T et al (2006) Comparison of limited and anatomic hepatic resection for hepatocellular carcinoma with hepatitis C. Surgery 139:385–394PubMedCrossRef
16.
Zurück zum Zitat Sobin LH, Wittekind C (eds) (1997) TNM classification of malignant tumors, 5th edn. Wiley, New York Sobin LH, Wittekind C (eds) (1997) TNM classification of malignant tumors, 5th edn. Wiley, New York
17.
Zurück zum Zitat Kubo S, Tsukamoto T, Hirohashi K et al (2003) Appropriate surgical management of small hepatocellular carcinomas in patients infected with hepatitis C virus. World J Surg 27:437–442PubMedCrossRef Kubo S, Tsukamoto T, Hirohashi K et al (2003) Appropriate surgical management of small hepatocellular carcinomas in patients infected with hepatitis C virus. World J Surg 27:437–442PubMedCrossRef
18.
Zurück zum Zitat Yamamoto J, Kosuge T, Takayama T et al (1996) Recurrence of hepatocellular carcinoma after surgery. Br J Surg 83:1219–1222PubMedCrossRef Yamamoto J, Kosuge T, Takayama T et al (1996) Recurrence of hepatocellular carcinoma after surgery. Br J Surg 83:1219–1222PubMedCrossRef
19.
Zurück zum Zitat Poon RT, Fan ST, Lo CM et al (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382PubMedCrossRef Poon RT, Fan ST, Lo CM et al (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382PubMedCrossRef
20.
Zurück zum Zitat Poon RT, Fan ST, Wong J et al (2000) Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 232:10–24CrossRef Poon RT, Fan ST, Wong J et al (2000) Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 232:10–24CrossRef
21.
Zurück zum Zitat Chen WT, Chau GY, Lui WY et al (2004) Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome. Eur J Surg Oncol 30:414–420PubMedCrossRef Chen WT, Chau GY, Lui WY et al (2004) Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome. Eur J Surg Oncol 30:414–420PubMedCrossRef
22.
Zurück zum Zitat Poon RT, Fan ST, Lo CM et al (1999) Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long term results of treatment and prognostic factors. Ann Surg 229:216–222PubMedCrossRef Poon RT, Fan ST, Lo CM et al (1999) Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long term results of treatment and prognostic factors. Ann Surg 229:216–222PubMedCrossRef
23.
Zurück zum Zitat Lee PH, Lin WJ, Tsang YM et al (1995) Clinical management of recurrent hepatocellular carcinoma. Ann Surg 222:670–676PubMedCrossRef Lee PH, Lin WJ, Tsang YM et al (1995) Clinical management of recurrent hepatocellular carcinoma. Ann Surg 222:670–676PubMedCrossRef
24.
Zurück zum Zitat Shimada M, Takenaka K, Taguchi K et al (1998) Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 227:80–85PubMedCrossRef Shimada M, Takenaka K, Taguchi K et al (1998) Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 227:80–85PubMedCrossRef
25.
Zurück zum Zitat Kosuge T, Makuuchi M, Takayama T et al (1993) Long-term results after resection of hepatocellular carcinoma: experience of 480 cases. Hepatogastroenterology 40:328–332PubMed Kosuge T, Makuuchi M, Takayama T et al (1993) Long-term results after resection of hepatocellular carcinoma: experience of 480 cases. Hepatogastroenterology 40:328–332PubMed
26.
Zurück zum Zitat Okada S, Shimada K, Yamamoto J et al (1994) Predictive factors for postoperative recurrence of hepatocellular carcinoma. Gastroenterology 106:1618–1624PubMed Okada S, Shimada K, Yamamoto J et al (1994) Predictive factors for postoperative recurrence of hepatocellular carcinoma. Gastroenterology 106:1618–1624PubMed
27.
Zurück zum Zitat Ryu M, Shimamura Y, Kinoshita T et al (1997) Therapeutic results of resection, transcatheter arterial embolization and percutaneous transhepatic ethanol injection in 3225 patients with hepatocellular carcinoma: a retrospective multicenter study. Jpn J Clin Oncol 27:252–257CrossRef Ryu M, Shimamura Y, Kinoshita T et al (1997) Therapeutic results of resection, transcatheter arterial embolization and percutaneous transhepatic ethanol injection in 3225 patients with hepatocellular carcinoma: a retrospective multicenter study. Jpn J Clin Oncol 27:252–257CrossRef
28.
Zurück zum Zitat Zhou XD, Tang ZY, Yu YQ et al (1994) Recurrence after resection of alpha-fetoprotein-positive hepatocellular carcinoma. J Cancer Res Clin Oncol 120:369–373PubMedCrossRef Zhou XD, Tang ZY, Yu YQ et al (1994) Recurrence after resection of alpha-fetoprotein-positive hepatocellular carcinoma. J Cancer Res Clin Oncol 120:369–373PubMedCrossRef
29.
Zurück zum Zitat Moriyama M, Matsumura H, Aoki H et al (2003) Long-term outcome, with monitoring of platelet counts, in patients with chronic hepatitis C and liver cirrhosis after interferon therapy. Intervirology 46:296–307PubMedCrossRef Moriyama M, Matsumura H, Aoki H et al (2003) Long-term outcome, with monitoring of platelet counts, in patients with chronic hepatitis C and liver cirrhosis after interferon therapy. Intervirology 46:296–307PubMedCrossRef
30.
Zurück zum Zitat Imai Y, Kawata S, Tamura S et al (1998) Relation of interferon therapy and hepatocellular carcinonma in patients with chronic hepatitis C. Osaka hepatocellular carcinoma prevention study group. Ann Intern Med 129:94–99PubMed Imai Y, Kawata S, Tamura S et al (1998) Relation of interferon therapy and hepatocellular carcinonma in patients with chronic hepatitis C. Osaka hepatocellular carcinoma prevention study group. Ann Intern Med 129:94–99PubMed
31.
Zurück zum Zitat Takano S, Yokosuka O, Imazeki F et al (1995) Incidence of hepatocellular carcinoma in chronic hepatitis B and C: a prospective study of 251 patients. Hepatology 21:650–655PubMedCrossRef Takano S, Yokosuka O, Imazeki F et al (1995) Incidence of hepatocellular carcinoma in chronic hepatitis B and C: a prospective study of 251 patients. Hepatology 21:650–655PubMedCrossRef
32.
Zurück zum Zitat Yoshida H, Shiratori Y, Moriyama M et al (1999) Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan IHIT Study Group. Ann Intern Med 131:174–181PubMed Yoshida H, Shiratori Y, Moriyama M et al (1999) Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan IHIT Study Group. Ann Intern Med 131:174–181PubMed
33.
Zurück zum Zitat Poynard T, Bedossa P, Opolon P et al (1997) Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINVIR and DOSVIRC groups. Lancet 349:825–832PubMedCrossRef Poynard T, Bedossa P, Opolon P et al (1997) Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINVIR and DOSVIRC groups. Lancet 349:825–832PubMedCrossRef
34.
Zurück zum Zitat Shibata M, Morizane T, Uchida T et al (1998) Irregular regeneration of hepatocytes and risk of hepatocellular carcinoma in chronic hepatitis and cirrhosis with hepatitis-C-virus infection. Lancet 351:1773–1777PubMedCrossRef Shibata M, Morizane T, Uchida T et al (1998) Irregular regeneration of hepatocytes and risk of hepatocellular carcinoma in chronic hepatitis and cirrhosis with hepatitis-C-virus infection. Lancet 351:1773–1777PubMedCrossRef
35.
Zurück zum Zitat Tarao K, Ohkawa S, Shimizu A et al (1994) Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients. Cancer 73:1149–1154PubMedCrossRef Tarao K, Ohkawa S, Shimizu A et al (1994) Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients. Cancer 73:1149–1154PubMedCrossRef
36.
Zurück zum Zitat Schmidt KG, Rasmussen JW, Bekker C et al (1985) Kinetics and in vivo distribution of 111-in labeled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol 34:39–46PubMedCrossRef Schmidt KG, Rasmussen JW, Bekker C et al (1985) Kinetics and in vivo distribution of 111-in labeled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol 34:39–46PubMedCrossRef
37.
Zurück zum Zitat Peck-Radosavljevic M, Zacher J, Meng YG et al (1997) Is inadequate thrombopoietin production a major cause of thrombocytopenia in cirrhosis of the liver? J Hepatol 27:127–131PubMedCrossRef Peck-Radosavljevic M, Zacher J, Meng YG et al (1997) Is inadequate thrombopoietin production a major cause of thrombocytopenia in cirrhosis of the liver? J Hepatol 27:127–131PubMedCrossRef
38.
Zurück zum Zitat Kawasaki T, Takeshita A, Souda K et al (1999) Serum thrombopoietin levels in patients with chronic hepatitis and liver cirrhosis. Am J Gastroenterol 94:1918–1922PubMedCrossRef Kawasaki T, Takeshita A, Souda K et al (1999) Serum thrombopoietin levels in patients with chronic hepatitis and liver cirrhosis. Am J Gastroenterol 94:1918–1922PubMedCrossRef
39.
Zurück zum Zitat Grober D, Giuliani D, Leevy CM et al (1984) Platelet associated IgG in hepatitis and cirrhosis. J Clin Immunol 4:109–113 Grober D, Giuliani D, Leevy CM et al (1984) Platelet associated IgG in hepatitis and cirrhosis. J Clin Immunol 4:109–113
40.
Zurück zum Zitat Nagamine T, Ohtuka T, Takehara K et al (1996) Thrombocytopenia associated with hepatitis C viral infection. J Hepatol 24:135–140PubMedCrossRef Nagamine T, Ohtuka T, Takehara K et al (1996) Thrombocytopenia associated with hepatitis C viral infection. J Hepatol 24:135–140PubMedCrossRef
41.
Zurück zum Zitat Lu SN, Wang JH, Liu SL et al (2006) Thrombocytopenia as surrogate for cirrhosis and a marker for the identification of patients at high risk for hepatocellular carcinoma. Cancer 107:2212–2222PubMedCrossRef Lu SN, Wang JH, Liu SL et al (2006) Thrombocytopenia as surrogate for cirrhosis and a marker for the identification of patients at high risk for hepatocellular carcinoma. Cancer 107:2212–2222PubMedCrossRef
42.
Zurück zum Zitat Kubo S, Tanaka H, Shuto T et al (2004) Correlation between low platelet count and multicentricity of hepatocellular carcinoma in patients with chronic hepatitis C. Hepatol Res 4:221–225CrossRef Kubo S, Tanaka H, Shuto T et al (2004) Correlation between low platelet count and multicentricity of hepatocellular carcinoma in patients with chronic hepatitis C. Hepatol Res 4:221–225CrossRef
43.
Zurück zum Zitat Lok AS, Seeff LB, Morgan TR et al (2009) Incidence of hepatocellular carcinoma and associated risk factors in hepatitis-C-related advanced liver disease. Gastroenterology 136:138–148PubMedCrossRef Lok AS, Seeff LB, Morgan TR et al (2009) Incidence of hepatocellular carcinoma and associated risk factors in hepatitis-C-related advanced liver disease. Gastroenterology 136:138–148PubMedCrossRef
44.
Zurück zum Zitat Kobayashi M, Ikeda K, Kawamura Y et al (2009) High serum des-gamma-carboxy prothrombin level predicts poor prognosis after radiofrequency ablation of hepatocellular carcinoma. Cancer 115:571–580PubMedCrossRef Kobayashi M, Ikeda K, Kawamura Y et al (2009) High serum des-gamma-carboxy prothrombin level predicts poor prognosis after radiofrequency ablation of hepatocellular carcinoma. Cancer 115:571–580PubMedCrossRef
45.
Zurück zum Zitat Minagawa M, Makuuchi M, Takayama T et al (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710PubMedCrossRef Minagawa M, Makuuchi M, Takayama T et al (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710PubMedCrossRef
Metadaten
Titel
Clinicopathological Features of Recurrence in Patients After 10-year Disease-free Survival Following Curative Hepatic Resection of Hepatocellular Carcinoma
verfasst von
Masaki Kaibori
Shoji Kubo
Hiroaki Nagano
Michihiro Hayashi
Seiji Haji
Takuya Nakai
Morihiko Ishizaki
Kosuke Matsui
Takahiro Uenishi
Shigekazu Takemura
Hiroshi Wada
Shigeru Marubashi
Koji Komeda
Fumitoshi Hirokawa
Yasuyuki Nakata
Kazuhisa Uchiyama
A-Hon Kwon
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 4/2013
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-1902-3

Weitere Artikel der Ausgabe 4/2013

World Journal of Surgery 4/2013 Zur Ausgabe

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.