Neue chirurgische Ansätze beim hepatozellulären Karzinom

Zusammenfassung

In den letzten Jahren hat sich die Behandlung des hepatozellulären Karzinoms (HCC) signifikant gewandelt. Die Einführung von sonografischen Screeningprogrammen für Patienten mit Leberzirrhose führt zunehmend zur Diagnose von HCC im Frühstadium. Die Leberresektion und Lebertransplantation stellen potenziell kurative Behandlungsoptionen dar. Sie können jedoch nur bei einer limitierten Anzahl von Patienten angewandt werden. Die Indikation zur Leberresektion besteht bei Patienten mit kleinem HCC und ohne Zirrhose. In Ausnahmefällen kann auch eine Resektion eines HCC in einer zirrhotischen Leber erfolgen, falls die Möglichkeit zur Lebertransplantation nicht gegeben ist. Die Lebertransplantation ist Methode der Wahl bei Patienten mit Zirrhose und einer Tumorgröße innerhalb der Milan-Kriterien. Der Mangel an Spenderorganen sowie die daraus resultierende Zeit auf der Warteliste sind prognoselimitierende Faktoren. Die transarterielle Chemoembolisation (TACE) und die Radiofrequenzablation (RFA) bieten die Möglichkeit einer lokalen Tumorkontrolle beim fortgeschrittenen HCC und werden zunehmend intraoperativ in Ergänzung zur Leberresektion eingesetzt. Das Langzeitüberleben wird signifikant durch das Auftreten von Lokalrezidiven oder Fernmetastasen eingeschränkt. Die Anwendung des Multikinase-Inhibitors Sorafenib in der (neo-)adjuvanten Situation wird gegenwärtig in prospektiven Studien untersucht.

Abstract

New advances in the treatment of HCC have emerged in recent years. The implementation of surveillance programmes has led to better diagnosis of HCC at early stages. Liver resection and liver transplantation remain the only potentially curative treatment options that can be applied in a limited number of patients resulting in 5-year survival rates as high as 75 – 80 %. Resection is indicated in patients with limited disease and absence of cirrhosis. Liver transplantation is beneficial in patients with cirrhosis and tumour size according to the Milan criteria. Organ donor shortage and the consequently long waiting time limits its applicability. TACE and radiofrequency ablation provide local tumour control in unresectable HCC and are increasingly used in addition to tumour resection. The major drawback of all treatments is the risk for local tumour recurrence or tumour progress during the waiting time for transplantation. The application of sorafenib in the (neo-)adjuvant situation is being tested in clinical trials.

Schlüsselwörter

hepatozelluläres Karzinom - Leberresektion - Lebertransplantation - Radiofrequenzablation

Key words

hepatocellular carcinoma - liver resection - liver ransplantation - radiofrequency ablation

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