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Chirurgische Therapie bei Lebertumoren – Leberresektion und -transplantation

Surgical treatment of hepatic tumors—liver resection and transplantation

Zusammenfassung

Die häufigsten primären malignen Lebertumoren sind das hepatozelluläre Karzinom (HCC) und das intrahepatische cholangiozelluläre Karzinom („intrahepatic cholangiocellular adenocarcinoma“ [iCCA]). Beim HCC in Zirrhose bietet die Lebertransplantation durch die vollständige Hepatektomie neben der größeren chirurgischen Radikalität auch den Vorteil der Entfernung des präkanzerotischen Zirrhosegewebes. Beim HCC in nichtzirrhotischer Leber stellt ebenso wie beim iCCA die Leberresektion die Behandlung der Wahl dar. Heutzutage können in erfahrenen Zentren auch ausgedehnte Leberresektionen mit einer überschaubaren Mortalität durchgeführt werden. Dabei sollte die chirurgische Behandlungsentscheidung in multimodale Konzepte eingebettet sein und im Rahmen interdisziplinärer Tumorkonferenzen mit entsprechender Expertise auf allen Gebieten erfolgen.

Abstract

The most frequent primary hepatic malignancies are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (intrahepatic cholangiocellular adenocarcinoma [iCCA]). For HCC in cirrhosis, liver transplantation offers the advantage of a complete hepatectomy radically removing all tumorous tissue along with the surrounding cirrhotic parenchyma, which is otherwise associated with a very high risk of recurrence. For HCC in non-cirrhotic livers and iCCA, liver resection is the treatment of choice. Nowadays, even extended resections can be performed with low mortality in experienced centers. Surgical therapy is more and more embedded into multimodal treatment concepts and decision making should be interdisciplinary as for other gastrointestinal tumors.

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Author information

Correspondence to Prof. Dr. H. Lang MA, MD, FACS.

Ethics declarations

Interessenkonflikt

H. Lang, S. Heinrich, F. Bartsch, F. Hüttl, J. Baumgart und J. Mittler geben an, dass kein Interessenkonflikt besteht und zur Erstellung dieses Artikels keine finanzielle Förderung bezogen wurde.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Manns, Hannover

T. Wirth, Hannover

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Lang, H., Heinrich, S., Bartsch, F. et al. Chirurgische Therapie bei Lebertumoren – Leberresektion und -transplantation. Internist 61, 147–157 (2020). https://doi.org/10.1007/s00108-020-00754-8

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Schlüsselwörter

  • Hepatozelluläres Karzinom
  • Intrahepatisches cholangiozelluläres Karzinom
  • Leberzirrhose
  • Technik der Leberresektion
  • Multimodale Therapie

Keywords

  • Carcinoma, hepatocellular
  • Cholangiocellular carcinoma, intrahepatic
  • Liver cirrhosis
  • Technique of liver resection
  • Combined modality therapy