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Resektion von Klatskin-Tumoren

Resection of Klatskin tumors

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Zusammenfassung

Klatskin-Tumoren können durch eine radikale Operationstaktik mit tumorferner Präparation kurativ behandelt und damit 5-Jahres-Überlebensraten von 30–50% erreicht werden. Dies erfordert zwingend eine Leberresektion en bloc mit extrahepatischer Gallengangresektion und oft auch eine zusätzliche vaskuläre Resektion. Trotzdem kann nicht immer der angestrebte Sicherheitsabstand von 0,5–1 cm jenseits der makroskopischen Tumorgrenzen eingehalten werden. Dabei gilt, dass anatomisch bedingt bei erweiterter Hemihepatektomie rechts mit Pfortadergabelresektion die Wahrscheinlichkeit eines ausreichenden Sicherheitsabstands höher ist als bei Hemihepatektomie links. Allerdings kommt bei einem Teil der Fälle aufgrund einer Atrophie des linken Lappens nur eine Hemihepatektomie links in Betracht. Sind beide Verfahren möglich, wird bei ausreichender Leberfunktion meist der erweiterten Hemihepatektomie rechts der Vorzug gegeben. Insbesondere Leberfunktionsstörungen, aber auch Galleleckagen nach anspruchsvoller biliärer Rekonstruktion – oft mit mehreren, zarten intrahepatischen Gallengängen – tragen zur Komplikationsrate bei diesem komplexen chirurgischen Krankheitsbild bei.

Abstract

Curative treatment of Klatskin tumors by radical surgical procedures with surgical preparation distant to the tumor region results in 5-year survival rates of 30–50%. This requires mandatory en bloc liver resection and resection of the extrahepatic bile duct often together with vascular resection. Nevertheless, the ideal safety margin of 0.5–1 cm remote from the macroscopic tumor extensions cannot be achieved in all cases. Based on hilar anatomy the probability of an adequate safety margin is higher using extended right hemihepatectomy together with portal vein resection compared to left hemihepatectomy. However, due to severe atrophy of the left liver lobe solely left-sided hepatectomy is feasible in some patients. In cases of eligibility for both procedures right hemihepatectomy is preferentially used due to the higher oncological radicality if sufficient liver function is present. Postoperative hepatic insufficiency and bile leakage after demanding biliary reconstruction, often with several small orifices, contribute to the postoperative complication rate of this complex surgical disease pattern.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    D. Seehofer, C. Kamphues & P. Neuhaus

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  1. D. Seehofer
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  2. C. Kamphues
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  3. P. Neuhaus
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Correspondence to D. Seehofer.

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Seehofer, D., Kamphues, C. & Neuhaus, P. Resektion von Klatskin-Tumoren. Chirurg 83, 221–228 (2012). https://doi.org/10.1007/s00104-011-2177-6

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