Strategie des chirurgischen Vorgehens beim hilären Cholangiokarzinom

Zusammenfassung

Die Operation ist die entscheidende lebensverlängernde Therapie des hilären Cholangiokarzinoms. Das chirurgische Vorgehen beruht auf retrospektiven Analysen. Da die Prognose nicht resezierter Patienten nur etwa 6 Monate beträgt, ist das Erzielen einer hohen Resektionsrate entscheidend. Die hierfür erforderliche diagnostische Abklärung des longitudinalen Tumorwachstums gelingt am besten durch perkutane transhepatische Cholangiographie. Im Ergebnis der Diagnostik wird die Tumorausdehnung eher über- als unterschätzt. Die Resektion sollte als en-bloc-Resektion von Tumor und Leber erfolgen. Unsicher ist, ob Art der Leberresektion, Umfang der Lymphadenektomie und die prinzipielle Mitresektion von Gefäßen die Prognose beeinflussen. Die Patienten im eigenen Krankengut überlebten nach Resektion 813, nach explorativer Laparotomie im Median 214 Tage. Die Resektionsrate betrug 71 %, die Rate kurativer Resektionen 72 %, die Operationsletalität 7 %. In der multivariaten Analyse war der Lymphknotenbefall der einzige signifikante prognostische Parameter.

Abstract

Surgery is the decisive life-prolongating treatment in patients with hilar cholangiocarcinoma. Surgery is mainly based on empiric data. Since patients without surgery have only about 6 months to survive, to achieve a high resection rate is crucial for these patients. During diagnostic workup, percutaneous transhepatic cholangiography results in the most reliable assessment of longitudinal tumor growth. The extent of the tumor is frequently overestimated leading to the consequence of exluding the patients from surgery. En-bloc resection of the tumor and the adjacent liver should be the preferred surgical approach. So far, surgical radicality (right trisegmentectomy, extended lymphadenectomy and vascular resection) has not been demonstrated to prolong survival. In our experience with 117 patients, median survival of patients following resection was 813 days, whereas patients not amenable to resection survived for 214 days only. Resection rate and the rate of curative resections were 71 and 72 %, respectively, operative mortality was 7 %. In the multivariate analysis, lymph node involvement proved to be the only prognostic marker.

hiläres Cholangiokarzinom - Resektion - Diagnostik - Prognose

hilar cholangiocarcinoma - surgery - diagnosis - prognosis

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