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Erschienen in: Die Onkologie 4/2022

14.03.2022 | Hepatozelluläres Karzinom | Leitthema

Aktueller Stand der operativen Therapie des hepatozellulären Karzinoms

verfasst von: PD Dr. Felix Oldhafer, Prof. Dr. Florian W. R. Vondran, Dr. Jens Mittler, Prof. Dr. Hauke Lang

Erschienen in: Die Onkologie | Ausgabe 4/2022

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Zusammenfassung

Hintergrund

Das hepatozelluläre Karzinom (HCC) ist das häufigste primäre Karzinom der Leber – mit steigender Inzidenz weltweit. Da etwa 90 % aller HCC auf dem Boden einer Leberzirrhose entstehen, richtet sich die Therapie nicht nur nach Tumorstadium und Allgemeinzustand des Patienten, sondern auch nach der Leberfunktion.

Ziel

Mit der vorliegenden Arbeit wird eine Übersicht über die chirurgische Therapie des HCC vor allem bei Patienten mit Leberzirrhose gegeben.

Methoden

Es erfolgte eine selektive Literaturrecherche in der Datenbank PubMed.

Ergebnisse und Schlussfolgerung

Die Leberresektion ist beim HCC in der nichtzirrhotischen Leber die Therapie der Wahl. Bei Patienten mit einem HCC in einer Leberzirrhose dient die Barcelona-Clinic-Liver-Cancer(BCLC)-Klassifikation als Grundlage für die Behandlungsentscheidung. Im Hinblick auf die Verbesserung der chirurgischen Therapie erscheint jedoch eine Ausweitung der Indikationen für die Leberresektion und Lebertransplantation in Zukunft sinnvoll. Nach entsprechender Patientenselektion anhand von Tumorgröße und -lokalisation sowie Tumormarkern kann eine Operation auch bei Patienten im mittleren oder fortgeschrittenen Stadium onkologisch sinnvoll sein. In diesem Zusammenhang sollte die laparoskopische Resektion insbesondere für Patienten evaluiert werden, bei denen eine Lebertransplantation geplant oder der Tumor leicht zugänglich ist. Eine Ausweitung der Priorisierung zur Lebertransplantation für Patienten mit einem HCC außerhalb der Mailand-Kriterien ist in den aktuellen deutschen Richtlinien nicht vorgesehen. Aufgrund der vielfältigen Behandlungsmöglichkeiten sollte eine individuelle Beurteilung jedes Patienten in einer interdisziplinären Tumorkonferenz erfolgen.
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Metadaten
Titel
Aktueller Stand der operativen Therapie des hepatozellulären Karzinoms
verfasst von
PD Dr. Felix Oldhafer
Prof. Dr. Florian W. R. Vondran
Dr. Jens Mittler
Prof. Dr. Hauke Lang
Publikationsdatum
14.03.2022
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 4/2022
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-022-01114-x

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