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Der Radiologe

, Volume 54, Issue 7, pp 673–678 | Cite as

Operative Therapie des hepatozellulären Karzinoms

  • S.A. Farkas
  • H.J. Schlitt
Leitthema

Zusammenfassung

Hintergrund

Kurative chirurgische Therapieverfahren für das hepatozelluläre Karzinom (HCC) sind die Resektion und die Lebertransplantation.

Methoden

Basis dieser Arbeit ist eine selektive Literaturübersicht zur Therapie des HCC. Die aktuelle S3-Leitlinie1 wurde ausführlich mit einbezogen, aber auch Leitlinien verschiedener Fachgesellschaften berücksichtigt.

Ergebnisse

Von entscheidender Bedeutung für die chirurgische Therapie ist die Einschätzung der Resektabilität, nicht nur im interdisziplinären Tumorboard, sondern auch in einem erfahrenen Leberzentrum. Primär resektable hepatozelluläre Karzinome bei Patienten ohne Leberzirrhose sollten reseziert werden. Für die Resektion kommen sowohl die Patienten in adäquatem Allgemeinzustand ohne Zirrhose als auch bei Patienten mit Child-A-Zirrhose ohne ausgeprägte portale Hypertension in Betracht. Bei der Resektion ist intraoperativer Ultraschall ein Standardverfahren. Auf die Leber beschränkte Rezidive können erneut operiert oder abladiert werden. Techniken zur erweiterten Leberresektion und laparoskopische Verfahren finden zunehmend Anwendung.

Schlussfolgerung

Neben der Resektion für Patienten ohne protale Hypertension ist die Lebertransplantation die chirurgische Therapie für Patienten mit HCC in Zirrhose. Innerhalb der Mailand-Kriterien können Patienten in Deutschland für eine Transplantation gelistet werden. Damit können 5-Jahres-Überlebensraten von 70–90 % erreicht werden. Allerdings führt der zunehmende Organmangel zu längeren Wartezeiten mit der Gefahr des Tumorprogresses. Deshalb muss eine engmaschige Kontrolle mit Schnittbildgebung durchgeführt werden und die Patienten chirurgisch mittels Resektion oder radiologisch mittels Radiofrequenzablation (RFA) oder transarterieller Chemoembolisation (TACE) „gebridget“ werden. Die Option einer Leberlebendspende sollte für diese Patienten geprüft werden, da hierbei die Wartezeit entfällt.

Schlüsselwörter

Leber Leberresektion Intraoperativer Ultraschall Zirrhose Lebertransplantation 

Operative therapy of hepatocellular carcinoma

Abstract

Background

Curative surgical strategies for hepatocellular carcinoma are liver resection and transplantation.

Methods

This overview is based on a selective literature search on therapeutic strategies for hepatocellular carcinoma. The new German S3 guidelines are outlined in detail but guidelines from other societies were also taken into consideration.

Results

The question of resectability is of utmost importance and should not only be evaluated in an interdisciplinary tumor board but also in an experienced liver center. Primary resectable hepatocellular carcinoma in patients without portal hypertension should be resected. Most patients without cirrhosis qualify for resection. In patients with Child grade A cirrhosis but without severe portal hypertension and a stable health status, a liver resection should be considered. At resection intraoperative ultrasound is standard. Intrahepatic tumor recurrences also can be re-resected or thermally ablated. New techniques for extended liver resections or minimally invasive liver resections are commonly used and have to be studied further.

Conclusion

In addition to liver resection, liver transplantation now represents a standard therapy for hepatocellular carcinoma in cirrhosis. Observing the Milan selection criteria 5-year survival rates of 70–90 % can be achieved; however, increasing organ shortage leads to longer waiting times and thus higher risk of tumor progression. Therefore, patients on the waiting list should have follow-up imaging and bridging with surgical resection, radiofrequency ablation (RFA) or transarterial chemoembolization (TACE) by interventional radiology. Living donor liver transplantation should be considered in all these patients with expected longer waiting times.

Keywords

Liver Liver resection Intraoperative ultrasound Cirrhosis Liver transplantation 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. S.A. Farkas weist auf folgende Beziehungen hin: research fund + sponsorship by Novartis, Astellas, Sanofi, Pfizer, Roche; H.J. Schlitt weist auf folgende Beziehungen hin: research and travel support Novartis, Astellas, Sanofi, Pfizer, Roche. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik und Poliklinik für ChirurgieUniversitätsklinikum RegensburgRegensburgDeutschland

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