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Therapieoptionen beim Hepatikusgabelkarzinom

Treatment options for cholangiocarcinoma

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Zusammenfassung

In der Therapie des Hepatikusgabelkarzinoms werden die günstigsten Langzeitüberlebensraten mit chirurgischen Konzepten erreicht, die onkologisch-chirurgische Prinzipien wie En-bloc-Resektion, No-touch-Techniken und möglichst weite, tumorfreie Resektionsränder umfassen. Derzeit erscheint unsere Strategie der Kombination einer erweiterten rechtsseitigen Leberteilresektion mit einer prinzipiellen Resektion der Pfortadergabel diesen Zielen am ehesten gerecht zu werden. Trotz einer Erweiterung der Resektabilitätskriterien auch auf bestimmte Patienten mit lokal fortgeschrittenen Tumoren, wie z. B. Bismuth-Corlette-Typ-IV-Tumoren, konnten formal kurative Resektionen bei 80% erreicht werden (Fünfjahresüberlebensrate 61%). Der Stellenwert der Lebertransplantation wird derzeit neu evaluiert, nachdem das Verfahren in den 80er-Jahren verlassen worden war. Der neue Aspekt, der eine Re-Evaluation der Transplantation rechtfertigt, ist eine von der Mayo-Klinik-Gruppe vorgestellte neoadjuvante Radiochemotherapie, die zu Fünfjahresüberlebensraten nach Transplantation von 83% führt. Hauptprobleme sind Komplikationen und Therapieversager, bei denen eine Transplantation trotz Radiochemotherapie nicht in Betracht kommt.

Abstract

Over the last decade, major progress has been made in liver resection as well as in liver transplantation for central cholangiocarcinoma. In our own experience of more than 270 patients in whom either resection or transplantation was performed during the last 19 years, a surgical concept combining an extended right hepatic resection and a principal portal vein resection has emerged as the most favorable technique. It achieves formally curative resections in 80% of the patients although a considerable share of patients suffering from Bismuth-Corlette type IV tumors is included. The 5-year survival rate in these patients is 61%. The most promising strategy in liver transplantation is based on neoadjuvant radiochemotherapy as proposed and reported by the Mayo Clinic group. The Mayo Clinic group has achieved a 5-year post-transplant survival of 83% in their patients, which is an outstanding and unprecedented figure that a few years ago would not have been considered to be a realistic goal in any type of treatment for cholangiocarcinoma.

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Authors and Affiliations

  1. Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    S. Jonas

  2. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité - Campus Virchow-Klinikum,Universitätsmedizin Berlin, Berlin, Deutschland

    T. Rösch

  3. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité - Campus Virchow-Klinikum,Universitätsmedizin Berlin, Berlin, Deutschland

    P. Neuhaus

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Correspondence to S. Jonas.

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Jonas, S., Rösch, T. & Neuhaus, P. Therapieoptionen beim Hepatikusgabelkarzinom. Gastroenterologe 3, 22–32 (2008). https://doi.org/10.1007/s11377-007-0134-1

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