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Frühkarzinom der Leber

Hepatozelluläres Karzinom

Early stage liver cancer

Hepatocellular carcinoma

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Zusammenfassung

Das hepatozelluläre Karzinom (HCC) zählt zu den häufigsten primären Malignomen der Leber. Hauptrisikofaktor für die Entstehung eines HCC ist die Leberzirrhose, deren Ausprägung, neben der Tumorausdehnung selbst, erhebliche Bedeutung hinsichtlich möglicher Therapieoptionen und der Prognose haben kann. Die Operation mit dem Ziel der R0-Resektion ist bei Patienten im frühen Stadium der Erkrankung die Therapie der Wahl und mit einem hohen Langzeit- und rezidivfreien Überleben assoziiert. Bei selektionierten Patienten mit HCC innerhalb der Milan-Kriterien kann durch Transplantation aufgrund der simultanen Behandlung der Leberzirrhose als Trigger eines möglichen HCC-Rezidivs ein noch besseres Langzeitüberleben nach 5 Jahren erreicht werden. Die lokale Tumorablation ist das kurative Therapieverfahren mit der geringsten Invasivität, welches allerdings mit einer erhöhten Lokalrezidivrate einhergeht. Somit kommt der frühen Diagnosestellung eine essenzielle Bedeutung zu. Da Symptome oftmals erst bei fortgeschrittenen Befunden auftreten, ist es unverzichtbar, Patienten mit typischen Risikofaktoren zu identifizieren und ihnen engmaschige Früherkennungsuntersuchungen anzubieten.

Abstract

Hepatocellular carcinoma (HCC) ranks among the most common primary cancers of the liver. The major risk factor for the formation of HCC is liver cirrhosis. The grade of cirrhosis as well as the extent of the tumor itself, can play an important role in the treatment options and patient prognosis. An operation aimed at an R0 resection is the treatment of choice for patients in an early stage of the disease and is associated with favorable long-term and recurrence-free survival. Liver transplantation offers an even better long-term survival rate after 5 years for selected patients with HCC meeting the Milan criteria as the underlying cirrhosis, the major risk factor for HCC recurrence, is simultaneously treated. Local tumor ablation is the least invasive curative surgical treatment, however, it is associated with an increased local recurrence rate; therefore, the early detection of tumors is of essential importance. As tumor-associated symptoms tend to arise only in advanced tumor stages, it is indispensable to identify patients with typical risk factors and to provide closely monitored screening examinations.

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Authors and Affiliations

  1. Klinik für Allgemeine Chirurgie, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland

    P. R. Scherber, G. Gäbelein, R. M. Eisele, D. Igna & M. Glanemann

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  1. P. R. Scherber
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  2. G. Gäbelein
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  3. R. M. Eisele
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  4. D. Igna
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  5. M. Glanemann
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Correspondence to M. Glanemann.

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Interessenkonflikt

P. R. Scherber, G. Gäbelein, R. M. Eisele, D. Igna und M. Glanemann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien

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Scherber, P.R., Gäbelein, G., Eisele, R.M. et al. Frühkarzinom der Leber. Chirurg 89, 281–288 (2018). https://doi.org/10.1007/s00104-017-0538-5

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  • DOI: https://doi.org/10.1007/s00104-017-0538-5

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