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Chirurgische Therapie des intrahepatischen cholangiozellulären Karzinoms

Surgical therapy of intrahepatic cholangiocellular carcinoma

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Zusammenfassung

Hintergrund

Intrahepatische cholangiozelluläre Karzinome (CCC) sind der zweithäufigste primäre epitheliale Lebertumor. Obwohl die Leberresektion die Therapie der Wahl darstellt, liegen bislang nur wenige valide Daten über den Wert dieser Therapieform vor. Wir verfolgen bei dieser Tumorentität einen aggressiven chirurgischen Therapienansatz.

Patienten und Methode

Von 04/1998 bis 06/2004 wurden bei 120 Patienten mit CCC 54 Leberresektionen durchgeführt. Zudem wurden bei 24 Patienten die folgenden 39 Operationserweiterungen vorgenommen: Hepatikusgabelresektion (n=18), Zwerchfellteilresektion (n=6), Gefäßresektion und -rekonstruktion (n=15).

Ergebnisse

Es wurden 30 R0-, 21 R1- und 3 R2-Resektionen erreicht. Nach inkompletter Resektion oder explorativer Laparotomie liegt das mediane Überleben bei 9 bzw. 6 Monaten. Demgegenüber beträgt das mediane Überleben nach R0-Resektion 46 Monate mit 1-/3-/5-Jahres-Überlebensraten von 83%/58%/48%.

Schlussfolgerung

Die Daten zeigen, dass auch beim CCC durch eine R0-Resektion eine signifikante Prognoseverbesserung erreicht werden kann. Die inkomplette Tumorentfernung führt dagegen zu nahezu keiner Verbesserung des Patientenüberlebens. Dies rechtfertigt ein aggressives chirurgisches Vorgehen bei dieser Tumorentität mit dem ausdrücklichen Ziel der RO-Resektion. Die niedrige Resektionsrate von weniger als 50% verdeutlicht die Notwendigkeit für ein verbessertes präoperatives Staging.

Abstract

Background

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy. Tumor resection is the treatment of choice, but so far the value of hepatic resection has not been well defined. We report results with an aggressive surgical approach for the treatment of this tumor entity.

Patients and methods

Between April 1998 and June 2004, 54 liver resections were performed in 120 patients with ICC. In 24 patients, 39 additional procedures were performed: resection of hilar bifurcation (n=18), partial resection of diaphragm (n=6), vascular resection and reconstruction (n=15).

Results

There were 30 R0, 21 R1, and three R2 resections. After R1/R2 resection and explorative laparotomy, the median survival times are 9 months and 6 months, respectively. Following R0 resection, the calculated median survival is 46 months, and the 1-, 3-, and 5-year survival rates are 83%, 58%, and 48%, respectively.

Conclusion

The presented data show that R0 resection leads to a significant prolongation of survival in patients with ICC. In contrast, incomplete tumor removal does not provide a survival benefit. These results justify an aggressive surgical approach to achieve a R0 resection. The low resectability rate of less than 50% underlines the need for improved preoperative staging.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen

    H. Lang, G. C. Sotiropoulos, E. Brokalaki, N. R. Frühauf, J. Radü, A. Paul, M. Malagó & C. E. Broelsch

  2. Institut für Pathologie, Universitätsklinikum Essen

    J. Wohlschlaeger & H. A. Baba

  3. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hufelandstraße 55, 45122 , Essen

    H. Lang

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  1. H. Lang
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  2. G. C. Sotiropoulos
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  4. N. R. Frühauf
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Correspondence to H. Lang.

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Lang, H., Sotiropoulos, G.C., Brokalaki, E. et al. Chirurgische Therapie des intrahepatischen cholangiozellulären Karzinoms. Chirurg 77, 53–60 (2006). https://doi.org/10.1007/s00104-005-1069-z

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