Zusammenfassung
GRUNDLAGEN: Die laufenden Entwicklungen bei den operativen und nicht-operativen Behandlungsmöglichkeiten haben das therapeutische Spektrum für primäre Lebermalignome beträchtlich erweitert, führen aber auch zur Notwendigkeit der exakten Auswertung ihrer Erfolge und der Erstellung von Richtlinien zu ihrer Anwendung. METHODIK: Aktuelle Publikationen und die Ergebnisse der Konsensuskonferenzen werden zur Beurteilung der derzeitigen Therpiemöglichkeiten bei primären Lebermalignomen herangezogen. ERGEBNISSE: Entsprechend den Mailänder Kriterien sind nur wenige Patienten mit hepatozellulärem Karzinom für eine Lebertransplantation geeignet. Die Früherkennung dieser Tumore durch Überwachung der Zirrhosepatienten ist entscheidend für den Erfolg des Transplantationskonzepts. Die Resektionsraten für das hepatozelluläre sowie für das intrahepatische und hiläre cholangiozelluläre Karzinom betragen etwa 10 bis 20 Prozent, wobei ein breiter Konsens darüber besteht, dass die R0-Resektion einen bedeutenden Prognosefaktor darstellt. Die Mehrheit der Patienten kann weder mit Transplantation noch mit Resektion behandelt werden. Für diese schwierige Patientengruppe wird eine Vielzahl von Therapiemöglichkeiten angegeben, ihre Wirksamkeit ist aufgrund der Verfälschung der Ergebnisse durch die Patientenauswahl und bedingt durch die großen Unterschiede zwischen den einzelnen Patienten sowie zwischen den behandelnden Institutionen schwer vergleichbar. Besonders zu den Eingriffen mit bislang vielversprechenden Ergebnissen wie zum Beispiel zur Radiofrequenz-Ablation brauchen wir weitere Studien, um klinische Entscheidungen auf der Grundlage eines hohen Evidenzgrades zu ermöglichen. SCHLUSSFOLGERUNGEN: Primäre Lebermalignome sollten in spezialisierten Zentren behandelt werden, von einem Team, das mit den speziellen Problemen dieser Patienten gut vertraut ist. Regelmäßige interdisziplinäre Konferenzen tragen entscheidend zur Optimierung des multimodalen Therapieansatzes bei. Richtlinien sind für das Therapiemanagement hilfreich, müssen jedoch individuell modifiziert und der spezifischen Situation jedes einzelnen Patienten angepasst werden.
Summary
BACKGROUND: Though recent developments in operative and non-operative therapy have added considerably to the therapeutic spectrum for primary hepatoma, there is a need for exact evaluation of their success and guidelines for their application. METHODS: Current therapeutic options for primary hepatoma are rated on the basis of recent publications and results of consensus conferences. RESULTS: According to the Milan criteria only a few patients with hepatocellular carcinoma are eligible for liver transplantation. Early detection of these tumours by surveillance of cirrhotic patients is essential for the success of the transplantation concept. Resection rates for hepatocellular and intrahepatic or hilar cholangiocellular carcinoma amount to about 10–20 %; there is wide consensus that R0-resection is a crucial prognostic factor. For the majority of patients neither transplantation nor resection is an option. For this very delicate patient group, a variety of therapeutic procedures are warranted with effects difficult to compare given the bias of patient selection and the great inter-patient and inter-institutional variability. Especially for procedures with promising results such as radiofrequency ablation, further studies are needed if clinical decisions are to be based on a high level of evidence. CONCLUSIONS: Primary hepatoma should be treated in specialised centres by a team that is truly dedicated to the very special problems of these patients and that holds regular interdisciplinary conferences to optimise the multimodal approach to this disease. Guidelines are helpful for treatment management but must be individually modified and tailored to the specific situation of every single patient.
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Cerwenka, H., Bacher, H. & Mischinger, HJ. Primary hepatoma – guidelines for interdisciplinary treatment. Eur Surg 38, 94–99 (2006). https://doi.org/10.1007/s10353-006-0227-y
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DOI: https://doi.org/10.1007/s10353-006-0227-y
Schlüsselwörter
- Primäre Lebertumore
- Hepatozelluläres Karzinom
- Cholangiozelluläres Karzinom
- Leberresektion
- Lebertransplantation
- Radiofrequenz-Ablation