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Klatskin-Tumoren: rationale Diagnostik und Staging

Klatskin tumors: rational diagnostics and staging

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Zusammenfassung

Klatskin-Tumoren stellen aufgrund ihres Wachstumsverhaltens und ihrer anatomischen Lage eine diagnostische Herausforderung im Tumorstaging dar. Dies spiegelt sich in der relativ konstanten Rate nicht kurativ zu resezierender Tumoren nach präoperativer Diagnostik. Der Beitrag erläutert die modernen bildgebenden und endoskopischen Verfahren zur präoperativen Diagnostik und ordnet sie hinsichtlich ihres Stellenwertes für die präoperative Einschätzung der Resektabilität ein.

Abstract

Klatskin tumors continue to be a challenge for diagnostic assessment and staging due to their longitudinal tumor growth along the perihilar bile ducts. Therefore the rate of non-resectable tumors remains relatively stable despite modern imaging and endoscopic techniques. This article reviews the current diagnostic methods for preoperative staging and the significance for predicting resectability.

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Literatur

  1. Aloia TA, Charnsangavej C, Faria S et al (2007) High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg 193:702–706

    Article  PubMed  Google Scholar 

  2. Bismuth H, Corlette MB (1975) Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg Gynecol Obstet 140:170–178

    PubMed  CAS  Google Scholar 

  3. Chikamoto A, Tsuji T, Takamori H et al (2006) The diagnostic efficacy of FDG-PET in the local recurrence of hilar bile duct cancer. J Hepatobiliary Pancreat Surg 13:403–408

    Article  PubMed  Google Scholar 

  4. Choi HS, Han JK, Lee JM et al (2005) Differentiating malignant from benign common bile duct stricture with multiphasic helical CT. Radiology 236:178–183

    Article  PubMed  Google Scholar 

  5. DeOliveira ML, Schulick RD, Nimura Y et al (2011) New staging system and a registry for perihilar cholangiocarcinoma. Hepatology 53:1363–1371

    Article  PubMed  Google Scholar 

  6. Bellis M de, Fogel EL, Sherman S et al (2003) Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc 58:176

    Article  PubMed  Google Scholar 

  7. Dumonceau JM, Casco C, Landoni N et al (2007) A new method of biliary sampling for cytopathological examination during endoscopic retrograde cholangiography. Am J Gastroenterol 102:550–557

    Article  PubMed  Google Scholar 

  8. Eloubeidi MA, Chen VK, Jhala NC et al (2004) Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma. Clin Gastroenterol Hepatol 2:209–213

    Article  PubMed  Google Scholar 

  9. Forsmo HM, Horn A, Viste A et al (2008) Survival and an overview of decision-making in patients with cholangiocarcinoma. Hepatobiliary Pancreat Dis Int 7:412–417

    PubMed  Google Scholar 

  10. Fritscher-Ravens A, Broering DC, Sriram PV et al (2000) EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: a case series. Gastrointest Endosc 52:534–540

    Article  PubMed  CAS  Google Scholar 

  11. Fukuda Y, Tsuyuguchi T, Sakai Y et al (2005) Diagnostic utility of peroral cholangioscopy for various bile-duct lesions. Gastrointest Endosc 62:374

    Article  PubMed  Google Scholar 

  12. Garrow D, Miller S, Sinha D et al (2007) Endoscopic ultrasound: a meta-analysis of test performance in suspected biliary obstruction. Clin Gastroenterol Hepatol 5:616–623

    Article  PubMed  Google Scholar 

  13. Hann LE, Greatrex KV, Bach AM et al (1997) Cholangiocarcinoma at the hepatic hilus: Sonographic findings. Am J Roentgenol 168:985–989

    CAS  Google Scholar 

  14. Jailwala J, Fogel EL, Sherman S et al (2000) Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc 51:383

    Article  PubMed  CAS  Google Scholar 

  15. Kawakami H, Kuwatani M, Onodera M et al (2011) Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 46:242–248

    Article  PubMed  Google Scholar 

  16. Kennedy TJ, Yopp A, Qin Y et al (2009) Role of preoperative biliary drainage of liver remnant prior to extended liver resection for hilar cholangiocarcinoma. HPB (Oxford) 11:445–451

    Google Scholar 

  17. Khan SA, Davidson BR, Goldin R et al (2002) Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 51(Suppl 6):1–9

    Article  Google Scholar 

  18. Kipp BR, Stadheim LM, Halling SA et al (2004) A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol 99:1675–1681

    Article  PubMed  Google Scholar 

  19. Klatskin G (1965) Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am J Med 38:241–256

    Article  PubMed  CAS  Google Scholar 

  20. Lee HY, Kim SH, Lee JM et al (2006) Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma: combined CT and cholangiography with revised criteria. Radiology 239:113–121

    Article  PubMed  Google Scholar 

  21. Lee SS, Kim MH, Lee SK et al (2002) MR cholangiography versus cholangioscopy for evaluation of longitudinal extension of hilar cholangiocarcinoma. Gastrointest Endosc 56:25–32

    Article  PubMed  Google Scholar 

  22. Levy C, Lymph J, Angulo P et al (2005) The value of serum Ca19–9 in predicting choangiocarcinoms in patients with primary sclerosing cholangitis. Dig Dis Sci 50:1734–1740

    Article  PubMed  CAS  Google Scholar 

  23. Li J, Kuehl H, Grabellus F et al (2008) Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol 98:438–443

    Article  PubMed  Google Scholar 

  24. Liu F, Li Y, Wie Y, Li B (2011) Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig Dis Sci 56:663–672

    Article  PubMed  Google Scholar 

  25. Masselli G, Manfredi R, Vecchioli A, Gualdi G (2008) MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings. Eur Radiol 18:2213–2221

    Article  PubMed  Google Scholar 

  26. Manfredi R, Brizi MG, Masselli G et al (2001) Malignant biliary hilar stenosis: MR cholangiographycompared with direct cholangiography. Radiol Med 102:48–54

    PubMed  CAS  Google Scholar 

  27. Nathan H, Aloia TA, Vauthey JN et al (2009) A proposed staging system for intrahepatic cholangiocarcinoma. Ann Surg Oncol 16:14–22

    Article  PubMed  Google Scholar 

  28. Okumoto T, Sato A, Yamada T et al (2009) Correct diagnosis of vascular encasement and longitudinal extension of hilar cholangiocarcinoma by fourchannel multidetector-row computed tomography. Tohoku J Exp Med 217:1–8

    Article  PubMed  Google Scholar 

  29. Park MS, Kim TK, Kim KW et al (2004) Differentiation of extrahepatic bile duct cholangiocarcinoma from benign stricture: findings at MRCP versus ERCP. Radiology 233:234

    Article  PubMed  Google Scholar 

  30. Patel AH, Harnois DM, Klee GG et al (2000) The utility of CA 19–9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol 95:204–207

    Article  PubMed  CAS  Google Scholar 

  31. Rösch T, Meining A, Frühmorgen S et al (2002) A prospective comparison of the diagnostic accuracy of ERCP, MRCP, CT, and EUS in biliary strictures. Gastrointest Endosc 55:870–876

    Article  PubMed  Google Scholar 

  32. Rösch T, Hofrichter K, Frimberger E et al (2004) ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc 60:390–396

    Article  PubMed  Google Scholar 

  33. Sharma MP, Ahuja V (1999) Aetiological spectrum of obstructive jaundice and diagnostic ability of ultrasonography: a clinician’s perspective. Trop Gastroenterol 20:167–169

    PubMed  CAS  Google Scholar 

  34. Shah RJ, Langer DA, Antillon MR et al (2006) Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreaticobiliary pathology. Clin Gastroenterol Hepatol 4:219

    Article  PubMed  Google Scholar 

  35. Siqueira E, Schoen R, Silverman W et al (2002) Detecting cholanagiocarcinoma in patients with primary sclerosing cholangitis. GI End 56:40–47

    Google Scholar 

  36. Stavropoulos S, Larghi A, Verna E et al (2005) Intraductal ultrasound for the evaluation of patients with biliary strictures and no abdominal mass on computed tomography. Endoscopy 37:715

    Article  PubMed  CAS  Google Scholar 

  37. Vazquez-Sequeiros E, Baron TH, Clain JE et al (2002) Evaluation of indeterminate bile duct strictures by intraductal US. Gastrointest Endosc 56:372

    Article  PubMed  Google Scholar 

  38. Weber A, Weyhern C von, Fend F et al (2008) Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol 14:1097

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Interdisziplinäre Endoskopie, Universitätsklinik Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    U.W. Denzer & T. Rösch

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  1. U.W. Denzer
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  2. T. Rösch
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Correspondence to U.W. Denzer.

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Denzer, U., Rösch, T. Klatskin-Tumoren: rationale Diagnostik und Staging. Chirurg 83, 215–220 (2012). https://doi.org/10.1007/s00104-011-2176-7

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  • DOI: https://doi.org/10.1007/s00104-011-2176-7

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