Chirurgische Therapie von Lebertumoren

Zusammenfassung

Die Leberchirurgie hat in den letzten beiden Jahrzehnten wesentlich an Bedeutung zugenommen. Hierzu haben detaillierte Kenntnisse über die funktionelle Anatomie der Leber, Verbesserungen in der bildgebenden Diagnostik und intensivmedizinischen Betreuung nach Leberresektion sowie vor allem operationstechnische Weiterentwicklungen auf dem Gebiet der Leberchirurgie selbst maßgeblich beigetragen. Insgesamt liegt die operationsbedingte Letalität bei Leberresektionen heutzutage deutlich unter 5 %. Dies erlaubt es, die Indikationsstellung auch bei ungünstig lokalisierten Tumoren großzügig zu stellen und immer weiter auszudehnen. Die vorliegende Arbeit gibt einen Überblick über den gegenwärtigen Stand der chirurgischen Resektion für die häufigsten benignen Leberveränderungen, das kavernöse Hämangiom, die fokal noduläre Hyperplasie und das hepatozelluläre Adenom, sowie für das cholangiozelluläre Karzinom und das hepatozelluläre Karzinome in zirrhotischer und nicht-zirrhotischer Leber.

Abstract

In the recent two decades liver surgery has gained tremendous progress due to developments in imaging modalities, perioperative management and surgical technique. Thus, overall mortality after liver resection has been reduced below 5 % allowing a more liberal indication for hepatic resection even in advanced and unfavorably located tumors. This paper gives an overview of the current status of liver resection for the three most frequent benign liver tumors, hemangioma, focal nodular hyperplasia and liver cell adenoma, for intrahepatic cholangiocellular carcinoma as well as for hepatocellular carcinoma with and without underlying cirrhosis including the rare type of fibrolamellar carcinoma.

Schlüsselwörter

benigne Lebertumoren - hepatozelluläres Karzinom - cholangiozelluläres Karzinom - Leberresektion

Key words

benign liver tumors - hepatocellular carcinoma - cholangiocellular carcinoma - liver resection

Literatur

• 1 Blumgart L E, Belghiti J. Liver resection for benign disease and for liver and biliary tumors. In: Surgery of the liver, biliary tract and pancreas. 4th Edition. Edited by Blumgart LH, Associate editors Belghiti J, Büchler M, Chapman W, D'Angelica M, DeMatteo RP, Hann L Jarnagin W. Saunders, London, Edinburgh, New York, Philadelphia, St. Louis, Sydney, Toronto 2006; 1341-1387
• 2 Ringe B, Canelo R, Lorf T. et al . Chirurgische Therapie benigner Lebertumoren.  Internist. 1997;  38 944-953
• 3 Weimann A, Ringe B, Klempnauer J. et al . Benign liver tumors: Differential diagnosis and indications for surgery.  World J Surg. 1997;  21 983-991
• 4 Baer H U, Dennison A R, Mouton W, Stain S C, Zimmermann A, Blumgart L H. Enucleation of giant hemangiomas of the liver.  Ann Surg. 1992;  216 673-676
• 5 Takayama T, Makuuchi M, Hirohashi S. et al . Malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma.  Lancet. 1990;  336 1150-1153
• 6 Flemming P, Lehmann U, Steinemann D, Kreipe H, Wilkens L. Leberzelladenom - Entartungspotenzial und Abgrenzung vom hepatozellulären Karzinom.  Pathologe. 2006;  27 238-243
• 7 Wilkens L, Bredt M, Flemming P. et al . Differentiation of liver cell adenomas from well-differentiated hepatocellular carcinomas by comparative genomic hybridization.  J Pathol. 2001;  193 476-482
• 8 Lehmann U, Berg-Ribbe I, Wingen L U. et al . Distinct methylation patterns of benign and malignant liver tumors revealed by quantitative methylation profiling.  Clin Cancer Res. 2005;  11 3654-3660
• 9 Erdogan D, Busch O R, van Delden O M, Ten Kate F J, Gouma D J, van Gulik T M. Management of spontaneous haemorrhage and rupture of hepatocellular adenomas. A single centre experience.  Liver Int. 2006;  26 433-438
• 10 Terkivatan T, de Wilt J H, de Man R A, van Rijn R R, Tilanus H W, Ijzrmans J N. Treatment of ruptured hepatocellular adenoma.  Br J Surg. 2001;  88 207-209
• 11 Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States.  Hepatology. 2001;  33 1353
• 12 Pichlmayr R, Lamesch P, Weimann A, Ringe B. Surgical treatment of cholangiocellular carcinoma.  World J Surg. 1995;  19 83-88
• 13 Lang H, Sotiropoulos G C, Brokalaki E. et al . Chirurgische Therapie des intrahepatischen cholangiozellulären Karzinoms.  Der Chirurg. 2006;  77 53-60
• 14 Weimann A, Varnholt H, Schlitt H J. et al . Retrospective analysis of prognostic factors after liver resection and transplantation for cholangiocarcinoma.  Br J Surg. 2000;  87 182
• 15 Casavilla F A, Wallis Marsh J W. et al . Hepatic resection and transplantation for peripheral cholangiocarcinoma.  J Am Coll Surg. 1997;  185 429-436
• 16 Hanazaki K, Kajikawa S, Shimozawa N. et al . Prognostic factors of intrahepatic cholangiocarcinoma after hepatic resection: univariate and multivariate analysis.  Hepatogastroenterology. 2002;  49 311
• 17 Harrison L E, Fong Y, Klimstra D S, Zee S Y, Blumgart L H. Surgical treatment of 32 patients with peripheral intrahepatic cholangiocarcinoma.  Br J Surg. 1998;  85 1068
• 18 Inoue K, Makuuchi M, Takayama T. et al . The separate-lesion type cholangiocarcinoma.  Surgery. 2000;  127 498
• 19 Kawarada Y, Yamagiwa K, Das B C. Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma.  Am J Surg. 2002;  183 679
• 20 Madariaga J R, Iwatsuki S, Todo S, Lee R G, Irish W, Starzl T E. Liver resection for hilar and peripheral cholangiocarcinomas: A study of 62 cases.  Ann Surg. 1998;  227 70-79
• 21 Ohtsuka M, Ito H, Kimura F. et al . Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing the survival.  Br J Surg. 2002;  89 1525
• 22 Roayaie S, Guarrera J V, Ye M Q. et al . Aggressive surgical treatment of intrahepatic cholangiocarcinoma: predictors of outcomes.  J Am Coll Surg. 1998;  187 365
• 23 Weber S M, Jarnagin W R, Klimstra D, DeMatteo R P, Fong Y, Blumgart L H. Intrahepatic cholangiocarcinoma: resectability, recurrence patterns, and outcomes.  J Am Coll Surg. 2001;  193 384
• 24 Lang H, Sotiropoulos G C, Dömland M. 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-years-period.  Ann Surg. 2005;  241 134
• 25 Lang H, Radtke A, Hindennach M. et al . Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection.  Arch Surg. 2005;  140 629-638
• 26 D'Angelica M, Fong Y, Weber S. et al . The role of staging laparoscopy in hepatobiliary malignancy:prospective analysis of 40 cases.  Ann Surg Oncol. 2003;  10 183
• 27 Sobin L H, Wittekind C H. TNM Classification of malignant tumours. Sixth edition. John Wiley & Sons Ltd., West Sussex 2002
• 28 Shimada M, Yamashita Y, Aishima S, Shirabe K, Takenaka K, Sugimachi K. Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma.  Br J Surg. 2001;  88 1463
• 29 Sotiropoulos G C, Lang H, Broelsch C E. Surgical management of recurrent intrahepatic cholangiocellular carcinoma after liver resection.  Surgery. 2005;  137 669-670
• 30 Bruix J, Sherman M. Management of hepatocellular carcinoma.  Hepatology. 2005;  42 1208-1236
• 31 Mazzaferro V, Regalia E, Doci R. et al . Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.  N Eng J Med. 1996;  334 693-699
• 32 Neuhaus P, Jonas S, Bechstein W O. Hepatoma of the liver - resection or transplantation.  Langenbeck's Arch Surg. 2000;  385 171-178
• 33 Bismuth H, Chiche L, Castaing D. Surgical treatment of hepatocellular carcinomas in noncirrhotic liver:experience with 68 liver resections.  World J Surg. 1995;  19 35-41
• 34 Lang H, Sotiropoulos G C, Dömland M. et al . Liver resection for hepatocellular carcinoma in the non-cirrhotic, non-fibrotic liver without underlying viral hepatitis.  Br J Surg. 2005;  92 198-202
• 35 Laurent C, Blanc J F, Nobili S. et al . Prognostic factors and longterm survival after hepatic resection for hepatocellular carcinoma originating from noncirrhotic liver.  J Am Coll Surg. 2005;  201 656-662
• 36 Houben W, McCall J L. Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: a systematic review.  Liver Transpl Surg. 1999;  5 91-95
• 37 Hemming A W, Reed A I, Howard R J. et al . Preoperative portal vein embolization for extended hepatectomy.  Ann Surg. 2003;  237 686-693
• 38 Chang C H, Chau G Y, Lui W Y. et al . Long-term results of hepatic resection for hepatocellular carcinoma originating from the noncirrhotic liver.  Arch Surg. 2004;  139 320-325
• 39 Chen M F, Tsai H P, Jeng L B. et al . Prognostic factors after resection for hepatocellular carcinoma in noncirrhotic livers:univariate and multivariate analysis.  World J Surg. 2003;  27 443-447
• 40 Dupont-Bierre E, Compagnon P, Raoul J L, Fayet, Lajarte-Thirouard A S, Boudjema K. Resection of hepatocellular carcinoma in noncirrhotic liver: analysis of risk factors for survival.  J Am Coll Surg. 2005;  201 663-670
• 41 Fong Y, Sun R L, Jarnagin W, Blumgart L H. An analysis of 412 cases of hepatocellular carcinoma at a western center.  Ann Surg. 1999;  229 790-800
• 42 Lang H, Sotiropoulos G C, Brokalaki E. et al . Survival and recurrence rates after resection of hepatocellular carcinoma in non-cirrhotic livers.  J Am Cll Surg. 2007;  ,  (in press)
• 43 Nagasue N, Ono T, Yamanoi A. et al . Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis.  Br J Surg. 2001;  88 515-522
• 44 Shimada M, Rikimaru T, Sugimachi K. et al . The importance of hepatic resection for hepatocellular carcinoma originating from nonfibrotic liver.  J Am Coll Surg. 2000;  191 531-537
• 45 Vauthey J N, Klimstra D, Franceschi D. et al . Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma.  Am J Surg. 1995;  169 28-35
• 46 Verhoef C, de Man R A, Zondervan P E. et al . Good outcomes after resection of large hepatocellular carcinoma in the non-cirrhotic liver.  Dig Surg. 2004;  21 380-386
• 47 Ercolani G, Grazi G L, Ravaioli M. et al . The role of lymphadenectomy for liver tumors - further considerations on the appropriateness of treatment strategy.  Ann Surg. 2004;  239 202-209
• 48 Portolani N, Coniglio A, Ghidoni S. et al . Early and late recurrence after liver resection for hepatocellular carcinoma - prognostic and therapeutic implications.  Ann Surg. 2006;  243 229-235
• 49 Boucher E, Corbinais S, Rolland Y. et al . Adjuvant intra-arterial injection of iodine-131-labeled lipiodol for resectable hepatocellular carcinoma.  Hepatology. 2003;  38 1237-1241
• 50 Partensky C, Sassolas G, Henry L. et al . Intra-arterial injection of iodine-131-labeled lipiodol as adjuvant therapy after curative liver resection for hepatocellular carcinoma: a phase 2 clinical study.  Arch Surg. 2000;  135 1298-1300
• 51 Neeleman N, Andersson R. Repeated liver resection for recurrent liver cancer.  Br J Surg. 1996;  83 893-901
• 52 Hemming A W, Langer B, Sheiner P, Greig P D, Taylor B R. Aggressive surgical management of fibrolamellar hepatocellular carcinoma.  J Gastrointest Surg. 1997;  1 342-346
• 53 Pinna A D, Iwatsuki S, Lee R G. et al . Treatment of fibrolamellar hepatoma with subtotal hepatectomy or transplantation.  Hepatology. 1997;  26 877-883
• 54 Ringe B, Wittekind C, Weimann A, Tusch G, Pichlmayr R. Results of hepatic resection and transplantation for fibrolamellar carcinoma.  Surg Gynecol Obstet. 1992;  175 299-305
• 55 Stipa F, Yoon S S, Liau K H, Fong Y. et al . Outcome of patients with fibrolamellar hepatocellular carcinoma.  Cancer. 2006;  106 1331-1338
• 56 Maeda T, Tsuneyoshi M, Takenaka K, Sugimachi K. Surgical treatment of patients with mixed hepatocellular carcinoma and cholangiocarcinoma.  Cancer. 1997;  80 514-515
• 57 Capussotti L, Muratore A, Massucco P, Ferrero A, Polastri R, Bozari H. Major liver resections for hepatocellular carcinoma on cirrhosis: early and long-term outcomes.  Liver Transpl. 2004;  10 64-68
• 58 Cha C H, Ruo L, Fong Y. et al . Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation.  Ann Surg. 2003;  238 315-323
• 59 Gouillat C, Manganas D, Saguier G, Duque-Campos R, Berard P. Resection of hepatocellular carcinoma in cirrhotic patients; long-term results in a prospective study.  J Am Coll Surg. 1999;  189 282-290
• 60 Grazi G L, Ercolani G, Pierangeli F. et al . Improved results of liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value.  Ann Surg. 2001;  234 71-78
• 61 Poon R T, Fan S T. Liver resection in cirrhosis of the liver. In: Surgery of the liver, biliary tract and pancreas. 4th Edition. Edited by Blumgart LH, Associate editors J. Belghiti, M. Büchler, W. Chapman, M. D'Angelica, R. P. DeMatteo, L. Hann & W. Jarnagin. Saunders, London, Edinburgh, New York, Philadelphia, St. Louis, Sydney, Toronto 2006; 1427-1439
• 62 Regimbeau J M, Abdalla E K, Vauthey J N. et al . Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: results of a multicenter study.  J Surg Oncol. 2004;  85 36-41
• 63 Yamamoto Y. Liver resection in cirrhosis.  Chirurg. 2001;  72 784-793
• 64 Yeh C N, Chen M F, Lee W C, Jeng L B. Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis.  J Surg Oncol. 2002;  81 195-202
• 65 Jonas S, Bechstein W O, Steinmüller T. et al . Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis.  Hepatology. 2001;  33 1080-1086
• 66 Ko S, Nakajima Y, Kanehiro H. et al . Significant influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy.  Ann Surg. 1996;  224 591-595
• 67 Poon R TP, Fan S T, Ng I OL, Wong J. Significance of resection margin in hepatectomy for hepatocellular carcinoma - A critical reappraisal.  Ann Surg. 2000;  231 544-551
• 68 Regimbeau J M, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J. Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma.  Surgery. 2006;  131 311-317
• 69 Uchida M, Kohno H, Kubota H. et al . Role of preoperative transcatheter arterial oily chemoembolization for resectable hepatocellular carcinoma.  World J Surg. 1996;  20 326-331
• 70 Ogata S, Belghiti J, Farges O, Varma D, Sibert A, Vilgrain V. Sequential arterial and portal vein embolizations bifore right hepatectomy in patients with cirrhosis and hepatocellular carcinoma.  Br J Surg. 2006;  93 1091-1098
• 71 Wu C C, Ho Y Z, Lin Ho W, Wu T C, Liu T J, P'Eng F K. Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal.  Br J Surg. 1995;  82 122-126
• 72 Otto G, Heuschen U, Hofmann W J, Krumm G, Hinz U, Herfarth C. Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis.  Ann Surg. 1998;  227 424-432