Peter Hohenberger – författare

Primary and metastasizing malignant carcinoma of the liv­ er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques­ tion is whether modem diagnostic methods and new thera­ peutic concepts can help to improve the prospects of treat­ ment. Of particular interest is the role played by therapeu­ tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys­ temic therapy and organ-related therapeutic methods, in­ cluding surgical resection, changes in the blood supply, re­ gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan­ dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top­ ics covered.

Primary and metastasizing malignant carcinoma of the liv­ er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques­ tion is whether modem diagnostic methods and new thera­ peutic concepts can help to improve the prospects of treat­ ment. Of particular interest is the role played by therapeu­ tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys­ temic therapy and organ-related therapeutic methods, in­ cluding surgical resection, changes in the blood supply, re­ gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan­ dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top­ ics covered.

Modern surgical oncology is characterized by multimodal therapy. In recent years numerous therapeutic approaches of pre-, peri-, intra-and postoperative treatment have been in­ vestigated with regard to their use in combination with surgi­ cal intervention. It now is time to analyze and to define the state of our knowledge. For tumors of the gastrointestinal tract there are several encouraging therapeutic approaches, such as preop­ erative chemotherapy in esophageal and perioperative chemotherapy in colon cancer. For some special tumors, like anal carcinoma, we have clearly defined combined therapies which even now must be viewed as standard treatment. It is also time to demonstrate the results of several clini­ cal studies that have been conducted within the last few years that combined surgical efforts with pre- or postinter­ ventional chemotherapy or radiotherapy. It is necessary to evaluate whether these trials contribute to progress in onco­ logical therapy. The editors of this volume - surgeons at the university hospitals of Heidelberg and Zurich - must be given the mer­ it of achieving these goals. It was especially appropriate for the Department of Surgery in Heidelberg, in close coopera­ tion with the Comprehensive Cancer Center Heidelberg/ Mannheim, to prepare a review of our present knowledge of surgical oncology as it is in the tradition of attempting to combine different therapeutic approaches to cancer therapy.