Summary
During the past 13 years a total of 60 patients (33 male, 27 female, median age 64.8 years) were operated upon and 21 of these patients underwent resection with a resectability rate of 35%. The remaining 39 patients had a palliative procedure. In 7 patients some form of bypass procedure was performed. 25 patients underwent some form of drainage procedure and in 7 patients only an explorative laparotomy was undertaken. Patients having resection surgery had a postoperative complication rate of 29% and there were 2 postoperative deaths (9.5%). The complication rate in the palliation group was 38%. The mean survival time in patients operated on with surgical resection was 34.1 months, palliative procedures 4.8 months and in patients with nonresectable tumors 3.6 months. In the resection group (n = 21) curative resection (= R0-resection) was performed in 14 patients, whereas in 7 patients there was a histologically invasion of the bile duct (= R0-resection). The mean survival time in the R0-group was 45.7 months and 11.8 months in the R1-group (Breslow p < 0.0098, Mantel-Cox p < 0.0070). we conclude that radical surgical resection offers the best possibility of prolonged survival with a good quality of life in patients with hilar cancer.
Zusammenfassung
Von 1977 bis 1989 werden 60 Patienten (33 Männer, 27 Frauen mit einem Durchschnittsalter von 64,8 Jahren) an der I. Chirurgischen Universitätsklinik in Wien operiert. 21 Bifurkationskarzinome konnten reseziert werden, das entspricht einer Resektionsrate von 35%. Bei 32 Patienten wurde eine Palliation und bei 7 eine Explorativ-Laparotomie durchgeführt. Die Komplikationsrate in der operablen Gruppe betrug 29%. 2 Patienten sind postoperativ verstorben, das entspricht einer Letalitätsrate von 9,5%. Die Komplikationsrate in der Gruppe der palliativ behandelten Gruppe war 38%. Die mittlere Überlebenszeit nach chirurgischer Resektion betrug 34,1 Monate, nach palliativer Maßnahme 4,8 Monate und nach Exploration 3,6 Monate. In der resezierten Gruppe (n = 21) waren in 14 Fällen kurative Resektionen (RO-Resektion) möglich, während in 7 Fällen eine histologische Tumorinfiltration am Resektat vorlag (R1-Resektion). Die mittlere Überlebenszeit in der R0-Gruppe betrug 45,7 Monate und 11,8 Monate in der R1-Gruppe (Breslow p < 0,009, Mantel-Cox p < 0,0070). Eine Verbesserung der Prognose und eine Verbesserung der Lebensqualität beim primären Karzinom der Hepaticusgabel kann neben einer Früherkennung nur durch die radikale Resektion erreicht werden.
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Teleky, B., Funovics, J.M., Herbst, F. et al. Chirurgische Therapie des proximalen Gallengangkarzinoms. Langenbecks Arch Chir 376, 286–290 (1991). https://doi.org/10.1007/BF00188269
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DOI: https://doi.org/10.1007/BF00188269