Die chirurgische Therapie proximaler extrahepatischer Gallengangstumoren (Klatskin-Tumoren)

Zusammenfassung

Aufgrund der anatomischen Lage, der diffusen Wachstumstendenz und der extrem schlechten Prognose ohne Therapie stellen Klatskin-Tumoren eine besondere Herausforderung für Diagnostik und Therapie dar. Anders als bei sonstigen Tumoren des Gastrointestinaltraktes, für die klare diagnostische und stadienabhängige Therapieempfehlungen ausgesprochen werden konnten, existiert für die Therapie von Klatskin-Tumoren keine einheitliche Vorgehensweise. So zeigen die Langzeitdaten nach den lokal begrenzten Resektionsverfahren, wie der Hepatikusgabelresektion, eine inakzeptabel hohe Rate an R 1 / 2-Resektionen und frühe Tumorrezidive. Durch Erweiterung des Eingriffs um eine Leberresektion lassen sich sowohl die Rate an R 0-Resektionen als auch das Langzeitüberleben verbessern. Die Erweiterung der Leberresektion um den linksmedialen Sektor plus Pfortadergabelresektion ergibt die höchste Rate an formal kurativen Resektionen hilärer Gallengangskarzinome. Die Langzeitüberlebensdaten zur Lebertransplantation bei Klatskin-Tumoren haben bisher nicht überzeugt. Die viel versprechenden ersten Daten zur Kombination von neoadjuvanter Therapie und Lebertransplantation zeigen aber mögliche Perspektiven in der chirurgischen Therapie von Klatskin-Tumoren.

Abstract

Due to their anatomical position, the tendency of early infiltrative growth and their poor prognosis without treatment, klatskin tumors are challenging concerning diagnosis and therapy. In contrast to other tumors of the gastrointestinal tract, for which exact diagnostic and stage dependent therapeutic guidelines could be formulated, clear recommendations for klatskin tumors are missing. Thus, survival rates after local resection, e. g. resection of the bile duct bifurcation alone, show high rates of R 1 / 2 resection and early tumor recurrence. With an additional hepatic resection formally curative resections and long-term survival can be improved. Extended liver resections including the portal vein provide the highest rates of R 0 resections for hilar carcinomas of the extrahepatic bile duct. Survival rates after liver transplantation for klatskin tumors are not yet convincing. Promising first results have been reported for the combination of neoadjuvant treatment and liver transplantation and might show future perspectives for the treatment of klatskin tumors.

Klatskin-Tumor - Gallengangskarzinom - Leberresektion - Lebertransplantation

Klatskin tumor - bile duct cancer - liver resection - liver transplantation

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