Malign Karaciğer Lezyonlarında Cerrahi Tedavinin Yeri: Rezeksiyon & Karaciğer Nakli
Özet
Malign karaciğer lezyonlarında cerrahi tedavinin yeri, onkolojik rezeksiyon ilkeleri ile karaciğer nakli ekseninde değerlendirilmektedir. Primer malign tümörlerde anatomik rezeksiyon tercih edilirken, metastazlarda sağlam cerrahi sınır sağlanarak nonanatomik yöntemler de uygulanabilir. Hepatoselüler karsinom ve intrahepatik kolanjiokarsinom tedavisinde cerrahi müdahale küratif seçenektir; fakat ameliyat sonrasında kalacak karaciğer dokusunun rezervi hayati önem taşır. Karaciğer fonksiyon kapasitesinin ölçümünde Child-Pugh sınıflaması ile transplantasyon önceliğini belirleyen MELD skorlaması aktif olarak kullanılır. Başlangıçta cerrahiye uygun olmayan kolorektal karaciğer metastazlarında ise neoadjuvan kemoterapi uygulamaları ve seçilmiş hastalarda karaciğer nakli sağkalım başarısını belirgin ölçüde yükseltmektedir.
Surgical management of malignant liver lesions is evaluated based on the principles of oncological resection and liver transplantation. While anatomical resection is preferred for primary malignant tumors, non-anatomical methods can be applied for metastases, provided that negative surgical margins are achieved. Surgery serves as a curative option in the treatment of hepatocellular carcinoma and intrahepatic cholangiocarcinoma; however, the functional reserve of the future liver remnant is vital. The Child-Pugh classification and MELD scoring systems are actively utilized to evaluate hepatic capacity and prioritize transplantation. For initially unresectable colorectal liver metastases, neoadjuvant chemotherapy schemes and liver transplantation in highly selected patients significantly improve overall survival outcomes.
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