Zusammenfassung
In den letzten Jahren hat sich die Behandlung des hepatozellulären Karzinoms (HCC)
signifikant gewandelt. Die Einführung von sonografischen Screeningprogrammen für Patienten
mit Leberzirrhose führt zunehmend zur Diagnose von HCC im Frühstadium. Die Leberresektion
und Lebertransplantation stellen potenziell kurative Behandlungsoptionen dar. Sie
können jedoch nur bei einer limitierten Anzahl von Patienten angewandt werden. Die
Indikation zur Leberresektion besteht bei Patienten mit kleinem HCC und ohne Zirrhose.
In Ausnahmefällen kann auch eine Resektion eines HCC in einer zirrhotischen Leber
erfolgen, falls die Möglichkeit zur Lebertransplantation nicht gegeben ist. Die Lebertransplantation
ist Methode der Wahl bei Patienten mit Zirrhose und einer Tumorgröße innerhalb der
Milan-Kriterien. Der Mangel an Spenderorganen sowie die daraus resultierende Zeit
auf der Warteliste sind prognoselimitierende Faktoren. Die transarterielle Chemoembolisation
(TACE) und die Radiofrequenzablation (RFA) bieten die Möglichkeit einer lokalen Tumorkontrolle
beim fortgeschrittenen HCC und werden zunehmend intraoperativ in Ergänzung zur Leberresektion
eingesetzt. Das Langzeitüberleben wird signifikant durch das Auftreten von Lokalrezidiven
oder Fernmetastasen eingeschränkt. Die Anwendung des Multikinase-Inhibitors Sorafenib
in der (neo-)adjuvanten Situation wird gegenwärtig in prospektiven Studien untersucht.
Abstract
New advances in the treatment of HCC have emerged in recent years. The implementation
of surveillance programmes has led to better diagnosis of HCC at early stages. Liver
resection and liver transplantation remain the only potentially curative treatment
options that can be applied in a limited number of patients resulting in 5-year survival
rates as high as 75 – 80 %. Resection is indicated in patients with limited disease
and absence of cirrhosis. Liver transplantation is beneficial in patients with cirrhosis
and tumour size according to the Milan criteria. Organ donor shortage and the consequently
long waiting time limits its applicability. TACE and radiofrequency ablation provide
local tumour control in unresectable HCC and are increasingly used in addition to
tumour resection. The major drawback of all treatments is the risk for local tumour
recurrence or tumour progress during the waiting time for transplantation. The application
of sorafenib in the (neo-)adjuvant situation is being tested in clinical trials.
Schlüsselwörter
hepatozelluläres Karzinom - Leberresektion - Lebertransplantation - Radiofrequenzablation
Key words
hepatocellular carcinoma - liver resection - liver ransplantation - radiofrequency
ablation
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Prof. Dr. J. Schmidt
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ruprecht-Karls-Universität
Im Neuenheimer Feld 110
69120 Heidelberg
Email: jan.schmidt@med.uni-heidelberg.de
