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Zentrale Gallengangskarzinome

Surgical therapy of hilar cholangiocarcinoma

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Zusammenfassung

Die R0-Resektion stellt derzeit die einzige potenziell kurative Therapieform des zentralen Gallengangskarzinoms dar. Die besondere anatomische Lokalisation der Tumoren mit unmittelbarer Nähe zu Leberarterie und Pfortader setzt dabei jedoch operationstechnische Grenzen und schränkt die Übertragbarkeit der Prinzipien der onkologischen Chirurgie ein. Lokale Resektionsverfahren wie die Hepatikusgabelresektion allein oder in Kombination mit limitierten Leberresektionen können mit geringer Morbidität und Mortalität durchgeführt werden, gehen aber mit einer hohen Lokalrezidivrate einher. Ausreichende Sicherheitsabstände können meistens nur durch ausgedehnte Leberresektionen erreicht werden. Die erweiterte Hemihepatektomie rechts („right trisectionectomy“) erlaubt eine weitgehend tumorferne Präparation und ermöglicht die potenziell größten tumorfreien Resektionsränder. Die berichteten 5-Jahre-Überlebensraten liegen zwischen 20% und 40%, in selektionierten Untergruppen sogar bis zu 59%. Die Verfügbarkeit neuer onkologischer Therapieprotokolle sowie insbesondere die Möglichkeit der Leberlebendspende könnten dafür sprechen, dass die Rolle der Lebertransplantation bei diesem Krankheitsbild neu zu definieren ist.

Abstract

Surgical resection provides the only chance of cure for patients suffering from hilar cholangiocarcinoma. Due to the central anatomic localization within the liver hilum, established guidelines of oncologic surgery are difficult to apply. Resection of the hilar bifurcation alone or in combination with limited hepatic resection can be performed with low morbidity and low mortality but shows a high rate of local tumor recurrence. Usually, extended resection is required to achieve adequate safety margins. Right trisectionectomy complies best with the basic rules of oncologic surgery while allowing the maximum safety margin. The 5-year survival rates reported after right trisectionectomy range between 20% and 40% and reach 59% in selected patients. The increasing experience with living donor transplantation and recent advances in neoadjuvant tumor therapy may lead to renewed discussion of liver transplantation in hilar cholangiocarcinoma.

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Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 , Essen

    H. Lang, G. M. Kaiser, G. C. Sotiropoulos, A. Frilling, M. Malagó & C. E. Broelsch

  2. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen

    T. Zöpf

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  1. H. Lang
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  2. G. M. Kaiser
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  3. T. Zöpf
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  4. G. C. Sotiropoulos
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  5. A. Frilling
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Correspondence to H. Lang.

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Lang, H., Kaiser, G.M., Zöpf, T. et al. Zentrale Gallengangskarzinome. Chirurg 77, 325–334 (2006). https://doi.org/10.1007/s00104-006-1177-4

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