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DOI: 10.1055/s-0032-1328024
Hiläres Cholangiokarzinom: rechts- versus linksseitige En-bloc-Resektion
Hilar Cholangiocarcinoma: Right versus Left HepatectomyPublication History
Publication Date:
21 December 2012 (online)
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Zusammenfassung
Einleitung: Typisches Vorgehen beim hilären Cholangiokarzinom ist die rechtsseitige Hemihepatektomie mit Segment 1 sowie Teilen oder des gesamten Segments 4. Wir sind in unserem Patientengut der Frage nachgegangen, ob die linksseitige Hemihepatektomie der Rechtsresektion onkologisch gleichwertig ist.
Patienten und Vorgehen: Bei 223 vorgestellten Patienten erfolgte 150-mal eine Resektion in kurativer Intention. Die Resektionen bestanden in 14 hilären, 68 Rechts- und 68 Linksresektionen.
Ergebnisse: Das Überleben kurativ und palliativ operierter Patienten war signifikant länger als nach Exploration oder ohne jede Operation (p = 0,0001). Das 5- und 10-Jahres-Überleben nach Rechts- und Linksresektion betrug 29 und 22 % gegenüber 21 und 7 % (p = 0,204). Bei Elimination der Krankenhausletalität war das Überleben nach Rechtsresektion marginal signifikant besser (p = 0,041). Die Krankenhausletalität betrug nach Rechtsresektion 13 %, nach Linksresektion 4 % (p = 0,069). Nach Rechtsresektion war die R-Situation von prognostischer Bedeutung (p = 0,038), nach Linksresektion die Lymphknotenbeteiligung (p = 0,01). Eine Gefäßresektion (bei Rechtsresektion als „hiläre En-bloc-Resektion“) war ohne Einfluss auf das Ergebnis.
Schlussfolgerungen: Bei im Vergleich zur Rechtsresektion niedrigerer Operationsletalität ist die Linksresektion trotz wahrscheinlich geringerer onkologischer Radikalität unverzichtbarer Bestandteil der chirurgischen Therapie des hilären Cholangiokarzinoms.
Abstract
Introduction: Right-sided hepatectomy including segment 1 and right trisectionectomy are typical approaches to surgical treatment of hilar cholangiocarcinoma. In this study we have compared the oncological capacity of this approach to left-sided hepatectomy.
Patients and Procedures: In 223 patients referred to our institution 150 hepatic resections were performed: 14 hilar resections, 68 right and 68 left hepatectomies.
Results: Survival after curative (R0) and palliative surgery was significantly superior to that in patient with exploration or no surgery at all (p < 0.0001). 5- and 10-year survival after right versus left hepatectomy was 29 and 22 % versus 21 and 7 % (p = 0.204). If hospital mortality was eliminated, survival after right hepatectomy was marginally significantly superior to that after left-sided hepatectomy (p = 0.041). Hospital mortality was 13 % after right compared to 4 % after left hepatectomy (p = 0.069). The R situation was of prognostic importance following right and the N situation after left hepatectomy (p = 0.038 and 0.01, respectively). Vascular resection – in right-sided procedures performed as “hilar en bloc resection” – did not influence the outcome.
Conclusions: Low perioperative mortality after left-sided resection and, obviously, inferior oncological radicality are features of left hepatectomy. These features do not detract from the importance of left hepatectomy which is an indispensable approach to surgically treated patients with hilar cholangiocarcinoma.
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