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Extrahepatische distale Gallenwegskarzinome

Carcinomas of the distal bile duct

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Zusammenfassung

Gallengangskarzinome werden je nach Lokalisation in intrahepatische, zentrale (perihiläre) oder distale Karzinome unterteilt. Distale Choledochuskarzinome stellen dabei ca. 25% der Gallengangskarzinome dar und können nochmals in mittlere und distale Karzinome unterteilt werden. Die chirurgische Intervention zur Erzielung einer kurativen Resektion (R0) leitet sich direkt von der Lokalisation ab. Während bei intrahepatischen und zentralen Gallengangskarzinomen das operative Vorgehen primär leberchirurgisch definiert ist, ist der Eingriff der Wahl beim distalen Karzinom die pyloruserhaltende partielle Duodenopankreatektomie. Im Falle eines kleineren, im mittleren drittel lokalisierten Karzinoms kann die alleinige Resektion des D. choledochus ohne Pankreaskopfresektion ausreichend sein. Das 5-Jahres-Überleben beim distalen Gallengangskarzinom nach radikaler Resektion liegt bei etwa 25%. Differenzialdiagnostisch muss das distale Gallengangskarzinom vom Adenokarzinom des Pankreas oder Karzinomen der Ampulla Vateri unterschieden werden. Durch eine radikale Resektion, möglichst im frühen Krankheitsstadium, ist eine Heilung grundsätzlich möglich. Welchen Stellenwert dabei eine erweiterte Lymphadenektomie hat, ist noch nicht geklärt. Ob eine Verbesserung des 5-Jahres-Überlebens nach erfolgreicher Resektion mit Hilfe neuer adjuvanter Therapiekonzepte (z. B. Gemcitabine oder Capecitabine) zu erreichen ist, sollte zukünftig im Rahmen klinischer Studien systematisch evaluiert werden.

Abstract

Malignancies of the biliary tree are classified into three groups according to location: intrahepatic, central (perihilar), and distal. Of all cholangiocarcinomas, 25% are located distally and can be subdivided into middle and lower bile duct carcinomas. Surgical approaches for achieving tumor-free resection margins (R0) are directly associated with the origin of the tumor. Intrahepatic and central cancers usually must be treated by liver surgery, whereas the majority of distal cholangiocarcinomas require pancreaticoduodenectomy. In case of a small, middle bile duct carcinoma, exclusive extrahepatic bile duct resection without pancreatic resection can be adequate. Five-year survival after radical resection is about 25%. Cancer of the distal bile duct has to be distinguished from ductal adenocarcinoma of the pancreas and carcinoma of the ampulla of Vater. Curative surgery is possible if the tumor is diagnosed early and radical resection is feasible. In this context, the role of an extended lymph node dissection remains unclear. To improve survival, future studies are needed to evaluate the role of novel adjuvant strategies (i.e., gemcitabine, capecitabine).

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  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin

    M. Bahra & J. M. Langrehr

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

    P. Neuhaus

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  1. M. Bahra
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  3. P. Neuhaus
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Correspondence to P. Neuhaus.

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Bahra, M., Langrehr, J.M. & Neuhaus, P. Extrahepatische distale Gallenwegskarzinome. Chirurg 77, 335–340 (2006). https://doi.org/10.1007/s00104-006-1160-0

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