Zusammenfassung
GRUNDLAGEN: Das Gallenblasenkarzinom (GBC) ist ein seltenes Karzinom, welches eine höhere Inzidenz bei Frauen als bei Männern hat. Das GBC hat zumeist eine schlechte Prognose. METHODIK: Es wird eine Übersicht über die Literatur und aktuelle therapeutische Konzepte gegeben. ERGEBNISSE: In der Karzinomentstehung scheint die chronische Entzündung und die Dysplasie eine größere Bedeutung zu haben als das Adenom. Der Ultraschall und das CT sind für die Evaluierung der lokalen Tumorextension sehr effektiv. Die Resektion ist die einzige kurative therapeutische Option beim GBC. Die Cholezystektomie ist die adäquate Therapie für T1-GBC. Im Falle von T2-Tumoren ist eine Leberresektion im Bereich des Gallenblasenbettes mit zumindest 2 cm Abstand und eine Lymphadenektomie wie bei T3/T4 erforderlich. Bei T3-Tumoren sollte der Leberresektionsrand zumindest 3 cm sein, und bei T4-Tumoren ist eine zusätzliche Resektion der extrahepatischen Gallenwege erforderlich. Die konservativen onkologischen Optionen für das GBC werden kontroversiell diskutiert. SCHLUSSFOLGERUNGEN: Eine frühe Tumordiagnose und eine radikale Resektion sind die einzigen Parameter, welche eine Heilung bei Patienten mit GBC ermöglichen, aber es ist nur bei einer geringen Patientenanzahl möglich.
Summary
BACKGROUND: Gallbladder cancer (GBC) is a rare malignancy which has a higher incidence in female than in male patients. GBC has usually a poor prognosis. METHODS: Review of literature and current therapeutic concepts. RESULTS: In the carcinogenesis of GBC chronic inflammation and dysplasia seem to be more important than adenoma. For the evaluation of the local tumor extension ultrasound and CT scan are most effective. Resection offers the only curative therapeutic option in GBC. Cholecystectomy is the adequate therapy for T1 GBC. In case of T2 tumors liver resection of the gallbladder bed with a parenchymal edge of at least 2 cm and lymphadenectomy like in T3/T4 are required. For T3 tumors the edge of resected liver parenchyma should be at least 3 cm and for T4 tumors an additional extrahepatic bile duct resection is necessary. Conservative oncological therapeutic options for GBC are discussed controversially. CONCLUSIONS: Early tumor detection and radical resection are the only parameters to cure GBC but it is just possible in a small number of patients.
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References
Wistuba II, Sugio K, Hung J, Kishimoto Y, Virmani AK, Roa I, Albores-Saavedra J, Gazdar AF (1995) Allele-specific mutations involved in the pathogenesis of endemic gallbladder carcinoma in Chile. Cancer Res 55: 2511–2515
Morris PJ MR (1994) Oxford Textbook of Surgery. New York, Oxford, Tokyo, Oxford University Press; pp 1240
Puhalla H, Bareck E, Scheithauer W, Ploner M, Stiglbauer W, Depisch D (2002) [Therapy of gallbladder carcinoma. Experience of a central hospital]. Chirurg 73: 50–56
Tahara E (1995) Genetic alterations in human gastrointestinal cancers. The application to molecular diagnosis. Cancer 75: 1410–1417
Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL (1988) Genetic alterations during colorectaltumor development. N Engl J Med 319: 525–532
Wilentz RE, Iacobuzio-Donahue CA, Argani P, McCarthy DM, Parsons JL, Yeo CJ, Kern SE, Hruban RH (2000) Loss of expression of Dpc4 in pancreatic intraepithelial neoplasia: evidence that DPC4 inactivation occurs late in neoplastic progression. Cancer Res 60: 2002–2006
Chang HJ, Kim SW, Kim YT, Kim WH (1999) Loss of heterozygosity in dysplasia and carcinoma of the gallbladder. Mod Pathol 12: 763–769
Wistuba II, Miquel JF, Gazdar AF, Albores-Saavedra J (1999) Gallbladder adenomas have molecular abnormalities different from those present in gallbladder carcinomas. Hum Pathol 30: 21–25
Sasatomi E, Tokunaga O, Miyazaki K (2000) Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular genetic findings. J Hepatobiliary Pancreat Surg 7: 556–567
Chang HJ, Jee CD, Kim WH (2002) Mutation and altered expression of beta-catenin during gallbladder carcinogenesis. Am J Surg Pathol 26: 758–766
Buckles DC, Lindor KD, Larusso NF, Petrovic LM, Gores GJ (2002) In primary sclerosing cholangitis, gallbladder polyps are frequently malignant. Am J Gastroenterol 97: 1138–1142
Lam CM, Yuen AW, Wai AC, Leung RM, Lee AY, Ng KK, Fan ST (2005) Gallbladder cancer presenting with acute cholecystitis: a population-based study. Surg Endosc 19: 697–701
Yanagisawa N, Mikami T, Yamashita K, Okayasu I (2003) Microsatellite instability in chronic cholecystitis is indicative of an early stage in gallbladder carcinogenesis. Am J Clin Pathol 120: 413–417
Tazuma S, Kajiyama G (2001) Carcinogenesis of malignant lesions of the gall bladder. The impact of chronic inflammation and gallstones. Langenbecks Arch Surg 386: 224–229
Sun XJ, Shi JS, Han Y, Wang JS, Ren H (2004) Diagnosis and treatment of polypoid lesions of the gallbladder: report of 194 cases. Hepatobiliary Pancreat Dis Int 3: 591–594
Yun EJ, Cho SG, Park S, Park SW, Kim WH, Kim HJ, Suh CH (2004) Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT. Abdom Imaging 29: 102–108
Sobin LH, Wittekind Ch (1997) UICC International Union against Cancer. TNM Classification of malignant tumours. 5th ed. New York, Chichester, Weinheim, Brisbane, Singapore, Toronto, Wiley-Liss, pp 78–80
Puhalla H, Wild T, Bareck E, Pokorny H, Ploner M, Soliman T, Stremitzer S, Depisch D, Laengle F, Gruenberger T (2002) Long-term follow-up of surgically treated gallbladder cancer patients. Eur J Surg Oncol 28: 857–863
Schauer RJ, Meyer G, Baretton G, Schildberg FJ, Rau HG (2001) Prognostic factors and long-term results after surgery for gallbladder carcinoma: a retrospective study of 127 patients. Langenbecks Arch Surg 386: 110–117
Wakai T, Shirai Y, Yokoyama N, Nagakura S, Watanabe H, Hatakeyama K (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88: 675–678
Fong Y, Jarnagin W, Blumgart LH (2000) Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 232: 557–569
Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M (1991) Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg 15: 337–343
Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, Tanaka M (2001) Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 192: 600–607
Todoroki T, Kawamoto T, Takahashi H, Takada Y, Koike N, Otsuka M, Fukao K (1999) Treatment of gallbladder cancer by radical resection. Br J Surg 86: 622–627
Cubertafond P, Gainant A, Cucchiaro G (1994) Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 219: 275–280
Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H (1992) Radical surgery for gallbladder carcinoma. Longterm results. Ann Surg 216: 565–568
Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH (1996) Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 224: 639–646
Yamaguchi K, Chijiiwa K, Ichimiya H, Sada M, Kawakami K, Nishikata F, Konomi K, Tanaka M (1996) Gallbladder carcinoma in the era of laparoscopic cholecystectomy. Arch Surg 131: 981–984
Fong Y, Heffernan N, Blumgart LH (1998) Gallbladder carcinoma discovered during laparoscopic cholecystectomy: aggressive reresection is beneficial. Cancer 83: 423–427
Kim EK, Lee SK, Kim WW (2002) Does laparoscopic surgery have a role in the treatment of gallbladder cancer? J Hepatobiliary Pancreat Surg 9: 559–563
Kraas E, Frauenschuh D, Farke S (2002) Intraoperative suspicion of gallbladder carcinoma in laparoscopic surgery: what to do? Dig Surg 19: 489–493
Wullstein C, Woeste G, Barkhausen S, Gross E, Hopt UT (2002) Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer? Surg Endosc 16: 828–832
Imhof M, Zacherl J, Rais A, Lipovac M, Jakesz R, Fuegger R (2002) Teaching laparoscopic cholecystectomy: do beginners adversely affect the outcome of the operation? Eur J Surg 168: 470–474
Sarli L, Contini S, Sansebastiano G, Gobbi S, Costi R, Roncoroni L (2000) Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer? Arch Surg 135: 1340–1344
Wibbenmeyer LA, Wade TP, Chen RC, Meyer RC, Turgeon RP, Andrus CH (1995) Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder. J Am Coll Surg 181: 504–510
Donohue JH, Stewart AK, Menck HR (1998) The National Cancer Data Base report on carcinoma of the gallbladder, 1989–1995. Cancer 83: 2618–2628
Fong Y, Brennan MF, Turnbull A, Colt DG, Blumgart LH (1993) Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination. Arch Surg 128: 1054–1056
Lundberg O, Kristoffersson A (1999) Port site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results of a Swedish survey and review of published reports. Eur J Surg 165: 215–222
Aoki Y, Shimura H, Li H, Mizumoto K, Date K, Tanaka M (1999) A model of port-site metastases of gallbladder cancer: the influence of peritoneal injury and its repair on abdominal wall metastases. Surgery 125: 553–559
Wade TP, Comitalo JB, Andrus CH, Goodwin MN Jr, Kaminski DL (1994) Laparoscopic cancer surgery. Lessons from gallbladder cancer. Surg Endosc 8: 698–701
Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K (2000) Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg 87: 418–422
Chijiiwa K, Noshiro H, Nakano K, Okido M, Sugitani A, Yamaguchi K, Tanaka M (2000) Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using western and Japanese classification systems. World J Surg 24: 1271–1276
Onoyama H, Yamamoto M, Tseng A, Ajiki T, Saitoh Y (1995) Extended cholecystectomy for carcinoma of the gallbladder. World J Surg 19: 758–763
Kosuge T, Sano K, Shimada K, Yamamoto J, Yamasaki S, Makuuchi M (1999) Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology 46: 2133–2137
Miyazaki M, Ito H, Nakagawa K, Ambiru S, Shimizu H, Okuno A, Nozawa S, Nukui Y, Yoshitomi H, Furuya S, Kusashio K, Nakajima N (1999) Does aggressive surgical resection improve the outcome in advanced gallbladder carcinoma? Hepatogastroenterology 46: 2128–2132
Sasson AR, Hoffman JP, Ross E, Meropol NJ, Szarka CE, Freedman G, Pinover W, Pingpank JF, Eisenberg BL (2001) Trimodality therapy for advanced gallbladder cancer. Am Surg 67: 277–283
Dvorak J, Jandik P, Melichar B, Jon B, Mergancova J, Zoul Z, Vacek Z, Petera J (2002) Intraluminal high dose rate brachytherapy in the treatment of bile duct and gallbladder carcinomas. Hepatogastroenterology 49: 916–917
Bruha R, Petrtyl J, Kubecova M, Marecek Z, Dufek V, Urbanek P, Kodadova J, Chodounsky Z (2001) Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies – the question of long-term palliation. Hepatogastroenterology 48: 631–637
Frezza EE, Mezghebe H (1997) Gallbladder carcinoma: a 28 year experience. Int Surg 82: 295–300
Gebbia V, Majello E, Testa A, Pezzella G, Giuseppe S, Giotta F, Riccardi F, Fortunato S, Colucci G, Gebbia N (1996) Treatment of advanced adenocarcinomas of the exocrine pancreas and the gallbladder with 5-fluorouracil, high dose levofolinic acid and oral hydroxyurea on a weekly schedule. Results of a multicenter study of the Southern Italy Oncology Group (G.O.I.M.). Cancer 78: 1300–1307
Kajanti M, Pyrhonen S (1994) Epirubicin-sequential methotrexate-5-fluorouracil-leucovorin treatment in advanced cancer of the extrahepatic biliary system. A phase II study. Am J Clin Oncol 17: 223–226
Andre T, Tournigand C, Rosmorduc O, Provent S, Maindrault-Goebel F, Avenin D, Selle F, Paye F, Hannoun L, Houry S, Gayet B, Lotz JP, de Gramont A, Louvet C, GERCOR Group (2004) Gemcitabine combined with oxaliplatin (GEMOX) in advanced biliary tract adenocarcinoma: a GERCOR study. Ann Oncol 15: 1339–1343
Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T; Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract (2002) Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 95: 1685–1695
Jazrawi S, Walsh TN, Byrne PJ, Hill AD, Li H, Lawlor P, Hennessy TP (1993) Cholecystectomy and oesophageal reflux: a prospective evaluation. Br J Surg 80: 50–53
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Puhalla, H., Laengle, F. Gallbladder cancer – only surgery is curative. Eur Surg 38, 100–106 (2006). https://doi.org/10.1007/s10353-006-0228-x
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DOI: https://doi.org/10.1007/s10353-006-0228-x