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Therapie des hepatozellulären Karzinoms in der zirrhotischen und nicht-zirrhotischen Leber

Treatment of hepatocellular carcinoma in the cirrhotic and non-cirrhotic liver

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Zusammenfassung

Hintergrund und Ziel der Arbeit

Die Therapie des hepatozellulären Karzinoms (HCC) umfasst chirurgische, interventionelle und systemische Ansätze. Diese Übersichtsarbeit beleuchtet den Stellenwert chirurgischer Therapieansätze in der multimodalen Behandlung des HCC unter Berücksichtigung aktueller Literatur, entsprechender deutscher Leit- und Richtlinien sowie Entwicklungen im Bereich der Organspende in Deutschland.

Ergebnisse

Kurative Therapieoptionen des HCC umfassen die Lebertransplantation, die Leberteilresektion und je nach Größe auch lokal ablative Verfahren. Beim HCC in der zirrhotischen Leber gilt beim Erfüllen der „Mailand-Kriterien“ die Lebertransplantation als Therapie der Wahl. In Anbetracht des Organmangels in Deutschland und verbesserter Ergebnisse nach Leberteilresektion kann bei ausreichender Leberfunktion alternativ eine Leberteilresektion erfolgen. Bei multinodulärem Befund, regionaler Lymphknotenmetastasierung oder Makrogefäßinvasion muss individuell über die Möglichkeit einer Resektion entschieden werden, wobei letztere beiden Kriterien eine Transplantation grundsätzlich ausschließen. Lokal ablative Verfahren können bei singulären, kleinen HCC alternativ zur Resektion in Abhängigkeit des Patientenwunsches erwogen werden. Ist eine kurativ intendierte Resektion des HCC in der nichtzirrhotischen Leber möglich, so orientieren sich die Strategien an den allgemeinen Grundsätzen der onkologischen Leberchirurgie.

Diskussion

Kurative Therapieoptionen des HCC umfassen die Lebertransplantation, die Leberteilresektion und lokal ablative Verfahren. Aktuelle Entwicklungen im Bereich der Organspende und technische Fortschritte in der minimal-invasiven Leberchirurgie sollten in die Entscheidungsfindung im Tumorboard einfließen.

Abstract

Background and objectives

The treatment of hepatocellular carcinoma (HCC) includes surgical, interventional and systemic approaches. This review highlights the importance of surgical treatment approaches in the multimodal treatment of HCC, based on the currently available literature, corresponding German guidelines as well as current developments in organ donation in Germany.

Results

Curative treatment options for HCC include liver transplantation, partial liver resection, and local ablative procedures depending on the lesion size. In the case of an early HCC in a cirrhotic liver fulfilling the Milan criteria, liver transplantation is the treatment of choice. In view of the organ shortage in Germany and improved results after partial liver resection, surgery can alternatively be performed in patients with a sufficient liver function. In selected patients with multinodular HCC, regional lymph node metastases or macrovascular invasion, the possibility of liver resection must be decided on an individual basis; however, the latter two criteria are contraindications for transplantation. Local ablative procedures can be considered as an alternative to resection in selected patients with early solitary HCC. Surgery of HCC in the non-cirrhotic liver with a curative intent is guided by the general principles of oncological liver surgery.

Discussion

Curative treatment options for HCC include liver transplantation, partial liver resection and local ablative procedures. Current developments in the area of organ donation and technical advances in minimally invasive liver surgery should be included in decision-making in tumor boards.

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Notes

  1. Organallokation in den Beneluxländern, Slowenien, Deutschland, Kroation, Österrreich und Ungarn.

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Authors and Affiliations

  1. Chirurgische Klinik, Campus Virchow-Klinikum und Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    M. Schmelzle, F. Krenzien, W. Schöning &  J. Pratschke

  2. Berlin Institute of Health (BIH), Berlin, Deutschland

    F. Krenzien

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  1. M. Schmelzle
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  2. F. Krenzien
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  4. J. Pratschke
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Correspondence to J. Pratschke.

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Interessenkonflikt

M. Schmelzle, F. Krenzien, W. Schöning und J. Pratschke geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Die Autoren M. Schmelzle und F. Krenzien haben zu gleichen Teilen zu der Arbeit beigetragen.

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Schmelzle, M., Krenzien, F., Schöning, W. et al. Therapie des hepatozellulären Karzinoms in der zirrhotischen und nicht-zirrhotischen Leber. Chirurg 89, 851–857 (2018). https://doi.org/10.1007/s00104-018-0690-6

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