Primäre Lebertumoren

Zu den primären Tumoren der Leber gehören das Cholangiokarzinom (CCA) und das hepatozelluläre Karzinom (HCC). Beide Tumorarten sind in Deutschland zunehmend verbreitet und daher aus chirurgischer sowie gastroonkologischer Sicht sehr bedeutsam. Nur unter Berücksichtigung der anatomischen Gegebenheiten sowie Tumor-Scores, einschließlich Berücksichtigung der Leberfunktion, gelingt es, für den Patienten eine individuelle Therapie festzulegen. Die Herausforderung dabei ist, stets Patienten mit dem gewählten Vorgehen nicht zu schaden, sondern wenn möglich eine kurative Therapie zu ermöglichen. Die chirurgische Resektion bzw. Lebertransplantation (LT) bleiben derzeit aber sowohl beim CCA als auch beim HCC die einzigen kurativen Optionen. Beim inoperablen CCA oder HCC sind neben der klassischen Chemotherapie auch lokoregionäre Therapien in unterschiedlichem Ausmaß einsetzbar und nehmen an Häufigkeit zu.

• Literatur

• 1 Greten TF, Malek NP, Schmidt S et al. Diagnosis of and therapy for hepatocellular carcinoma. Z Gastroenterol 2013; 51: 1269-1326
• 2 Majno P, Mentha G, Toso C et al. Anatomy of the liver: an outline with three levels of complexity – a further step towards tailored territorial liver resections. J Hepatol 2014; 60: 654-662
• 3 Golriz M, Majlesara A, El Sakka S et al. Small for Size and Flow (SFSF) syndrome: An alternative description for posthepatectomy liver failure. Clin Res Hepatol Gastroenterol 2015;
• 4 Kawasaki S, Makuuchi M, Kakazu T et al. Resection for multiple metastatic liver tumors after portal embolization. Surgery 1994; 115: 674-677
• 5 Adam R, Laurent A, Azoulay D et al. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors. Ann Surg 2000; 232: 777-785
• 6 Jaeck D, Oussoultzoglou E, Rosso E et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 2004; 240: 1037-1049 discussion 49–51
• 7 Nadalin S, Capobianco I, Li J et al. Indications and limits for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Lessons learned from 15 cases at a single centre. Z Gastroenterol 2014; 52: 35-42
• 8 Nadalin S, Testa G, Malago M et al. Volumetric and functional recovery of the liver after right hepatectomy for living donation. Liver Transpl 2004; 10: 1024-1029
• 9 Jochum C, Beste M, Penndorf V et al. Quantitative liver function tests in donors and recipients of living donor liver transplantation. Liver Transpl 2006; 12: 544-549
• 10 Jara M, Reese T, Malinowski M et al. Reductions in post-hepatectomy liver failure and related mortality after implementation of the LiMAx algorithm in preoperative work-up: a single-centre analysis of 1170 hepatectomies of one or more segments. HPB (Oxford) 2015; 17: 651-658
• 11 Lang H, Sotiropoulos GC, Fruhauf NR et al. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg 2005; 241: 134-143
• 12 Jonas S, Thelen A, Benckert C et al. Extended liver resection for intrahepatic cholangiocarcinoma: A comparison of the prognostic accuracy of the fifth and sixth editions of the TNM classification. Ann Surg 2009; 249: 303-309
• 13 Rana A, Hong JC. Orthotopic liver transplantation in combination with neoadjuvant therapy: a new paradigm in the treatment of unresectable intrahepatic cholangiocarcinoma. Curr Opin Gastroenterol 2012; 28: 258-265
• 14 Valle J, Wasan H, Palmer DH et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362: 1273-1281
• 15 Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 1992; 215: 31-38
• 16 Jonas S, Steinmüller T, Neuhaus P. [Surgical therapy of liver hilus tumors]. Chirurg 2001; 72: 775-783
• 17 Seehofer D, Kamphues C, Neuhaus P. [Resection of Klatskin tumors]. Chirurg 2012; 83: 221-228
• 18 Nanashima A, Yamaguchi H, Shibasaki S et al. Adjuvant photodynamic therapy for bile duct carcinoma after surgery: a preliminary study. J Gastroenterol 2004; 39: 1095-1101
• 19 Kaiser GM, Frühauf NR, Lang H et al. Impact of intraoperative radiotherapy (IORT) on survival of patients with unresectable hilar cholangiocarcinoma. Hepatogastroenterology 2008; 55: 1951-1954
• 20 Rauchfuss F, Utess F, Schule S et al. [Liver transplantation for hilar cholangiocarcinoma]. Chirurg 2012; 83: 229-237
• 21 Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma. Transpl Int 2010; 23: 692-697
• 22 Schule S, Altendorf-Hofmann A, Utess F et al. Liver transplantation for hilar cholangiocarcinoma – a single-centre experience. Langenbecks Arch Surg 2013; 398: 71-77
• 23 Hong JC, Petrowsky H, Kaldas FM et al. Predictive index for tumor recurrence after liver transplantation for locally advanced intrahepatic and hilar cholangiocarcinoma. J Am Coll Surg 2011; 212: 514-520 discussion 20–21
• 24 Patel J, Rizk N, Kahaleh M. Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma. Best Pract Res Clin Gastroenterol 2015; 29: 309-318
• 25 European Association for Study of Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Eur J Cancer 2012; 48: 599-641
• 26 Llovet JM, Fuster J, Bruix J et al. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 2004; 10: S115-S120
• 27 Malek NP, Schmidt S, Huber P et al. The diagnosis and treatment of hepatocellular carcinoma. Dtsch Arztebl Int 2014; 111: 101-106
• 28 AWMF. Leitlinienreport der S3-Leitlinie Diagnostik und Therapie des hepatozellulären Karzinoms 2013.. Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/032-053OLm_S3_Hepatozellul%25C3%25A4res_Karzinom_Diagnostik_Therapie_2013-05.pdf Stand: 24.01.2016
• 29 Berzigotti A, Reig M, Abraldes JG et al. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology 2015; 61: 526-536
• 30 Cillo U. Personal communication with Prof. U. Cillo, University di Padova, Italy, October 2015.
• 31 Anwar SL, Lehmann U. MicroRNAs: Emerging novel clinical biomarkers for hepatocellular carcinomas. J Clin Med 2015; 4: 1631-1650
• 32 Kluger MD, Salceda JA, Laurent A et al. Liver resection for hepatocellular carcinoma in 313 western patients: tumor biology and underlying liver rather than tumor size drive prognosis. J Hepatol 2015; 62: 1131-1140
• 33 Pant V, Sen IB, Soin AS. Role of ¹⁸F-FDG PET CT as an independent prognostic indicator in patients with hepatocellular carcinoma. Nucl Med Commun 2013; 34: 749-757
• 34 Tsuchiya N, Sawada Y, Endo I et al. Biomarkers for the early diagnosis of hepatocellular carcinoma. World J Gastroenterol 2015; 21: 10573-10583
• 35 Clavien PA, Lesurtel M, Bossuyt PM et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol 2012; 13: e11-e22
• 36 Schmidt C, Marsh JW. Molecular signature for HCC: role in predicting outcomes after liver transplant and selection for potential adjuvant treatment. Curr Opin Organ Transplant 2010; 15: 277-282
• 37 Yao FY, Mehta N, Flemming J et al. Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology 2015; 61: 1968-1977