We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Skip to main content
SpringerLink

Das intrahepatische Cholangiokarzinom

Ergebnisse nach 84 Resektionen

Intrahepatic cholangiocarcinoma

Results after 84 resections

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Inzidenz intrahepatischer Cholangiokarzinome (ICC) nimmt weltweit zu. Eine Resektion ist die einzige kurative Behandlungsmöglichkeit.

Ziel der Arbeit

Ziel der Arbeit war die Analyse prognostischer Faktoren nach der Resektion intrahepatischer Cholangiokarzinome.

Material und Methoden

Insgesamt 84 Patienten wurden unter potenziell kurativer Intention reseziert. Perihiläre und distale Gallengangskarzinome wurden ausgeschlossen. Analysiert wurde das 5‑Jahres-Überleben u. a. in Abhängigkeit vom Tumorstadium (TNM), von der Anzahl der resezierten Herde, dem Resektionsstatus (R0), dem Vorliegen einer Peritonealkarzinose und den postoperativen Komplikationen.

Ergebnisse

Das 5‑Jahres-Überleben lag bei 27 %. 77 % der Patienten wurden R0-reseziert. In der univariaten Analyse waren ein T‑Stadium >2, eine N+-Situation, eine R+-Resektion, ein peritonealer und ein multilokulärer Befall signifikant mit einer schlechteren Prognose vergesellschaftet. Das Auftreten von Komplikationen verschlechterte das Überleben ebenfalls signifikant. Multivariat zeigte sich das Fehlen einer Peritonealkarzinose, der negative Lymphknotenstatus, ein singulärer Leberherd, ein niedriges T‑Stadium sowie das Fehlen von Komplikationen als prognostisch günstig.

Diskussion

Die Prognose des ICC ist auch bei erfolgreicher Resektion schlecht. Klassische Tumorcharakteristika, wie das TNM-Stadium, sind relevante Risikofaktoren. Die Resektion geht mit Komplikationen (vor allem der Gallenwege) einher, die das Überleben negativ beeinflussen. Adjuvante Therapiestrategien werden dringend benötigt, um das Langzeitüberleben auch bei chirurgisch erfolgreich therapierten Patienten zu verbessern.

Abstract

Background

The incidence of intrahepatic cholangiocarcinoma (ICC) is increasing worldwide. Surgical resection is the only curative treatment option.

Aim of the study

This study analyzed the prognostic factors after resection of ICC.

Material and methods

A total of 84 patients were surgically treated under potentially curative intent. Perihilar and distal cholangiocarcinomas were excluded. The 5‑year survival was analyzed with respect to tumor stage (TNM), number of lesions, complete surgical resection (R0), peritoneal carcinosis and postoperative complications.

Results

The 5‑year survival was 27% and 77% of patients underwent R0 resections. In the univariate analysis a T stage >2, an N+ situation or an R+ resection as well as peritoneal and multilocular intrahepatic spread were associated with a poorer prognosis. Postoperative complications also negatively influenced survival. On multivariate analysis the absence of peritoneal spread, node-negative tumor stages, singular hepatic lesions and a low T stage as well as the absence of complications were associated with improved survival.

Discussion

The prognosis of ICC is poor even after successful surgical resection. Well-known tumor characteristics such as TNM are relevant prognostic factors. Surgical resection is accompanied by postoperative complications (most frequently biliary), which negatively influence survival. Adjuvant strategies are urgently needed to improve long-term survival even after complete surgical resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Juntermanns B, Fingas CD, Sotiropoulos GC, Jaradat D, Dechêne A, Reis H et al (2016) Klatskin tumor: long-term survival following surgery. Chirurg 87(6):514–519

    Article  CAS  PubMed  Google Scholar 

  2. Khan SA, Emadossadaty S, Ladep NG, Thomas HC, Elliott P, Taylor-Robinson SD, Toledano MB (2012) Rising trends in cholangiocarcinoma: is the ICD classification system misleading us? J Hepatol 56(4):848–854

    Article  PubMed  Google Scholar 

  3. von Hahn T, Ciesek S, Wegener G, Plentz RR, Weismüller TJ, Wedemeyer H et al (2011) Epidemiological trends in incidence and mortality of hepatobiliary cancers in Germany. Scand J Gastroenterol 46(9):1092–1098

    Article  Google Scholar 

  4. Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V., Robert Koch-Institut (2013) Krebs in Deutschland 2009/2010. https://www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GBEDownloadsB/KID2013.pdf;jsessionid=7DA7C4F7F42B27C05E55A1A3AB6B85F6.1_cid363?__blob=publicationFile

  5. Shaib YH, Davila JA, McGlynn K, El-Serag HB (2004) Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase? J Hepatol 40(3):472–477

    Article  PubMed  Google Scholar 

  6. Kumagai S, Sobue T, Makiuchi T, Kubo S, Uehara S, Hayashi T et al (2016) Relationship between cumulative exposure to 1,2-dichloropropane and incidence risk of cholangiocarcinoma among offset printing workers. Occup Environ Med 73(8):545–552

    Article  PubMed  Google Scholar 

  7. Welzel TM, Graubard BI, El-Serag HB, Shaib YH, Hsing AW, Davila JA, McGlynn KA (2007) Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study. Clin Gastroenterol Hepatol 5(10):1221–1228

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  9. http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=DE&Expert=70567. Zugegriffen: 19.02.2018

  10. Bagante F, Spolverato G, Cucchetti A, Gani F, Popescu I, Ruzzenente A et al (2016) Defining when to offer operative treatment for intrahepatic cholangiocarcinoma: a regret-based decision curves analysis. Surgery 160(1):106–117

    Article  PubMed  Google Scholar 

  11. Park J, Kim MH, Kim KP, Park DH, Moon SH, Song TJ et al (2009) Natural history and prognostic factors of advanced cholangiocarcinoma without surgery, chemotherapy, or radiotherapy: a large-scale observational study. Gut Liver 3(4):298–305

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Konstantinidis IT, Arkadopoulos N, Ferrone CR (2016) Surgical management of intrahepatic cholangiocarcinoma in the modern era: advances and challenges. Chin Clin Oncol 5(1):9

    PubMed  Google Scholar 

  13. Primrose JN, Fox R, Palmer DH, Prasad R, Mirza D, Anthoney DA et al (2017) Adjuvant capecitabine for biliary tract cancer: the BILCAP randomized study. J Clin Oncol 35(15_suppl):4006–4006

    Google Scholar 

  14. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A et al (2010) Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362(14):1273–1281

    Article  CAS  PubMed  Google Scholar 

  15. DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD et al (2007) Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg 245(5):755–762

    Article  PubMed  PubMed Central  Google Scholar 

  16. Choi SB, Kim KS, Choi JY, Park SW, Choi JS, Lee WJ, Chung JB (2009) The prognosis and survival outcome of intrahepatic cholangiocarcinoma following surgical resection: association of lymph node metastasis and lymph node dissection with survival. Ann Surg Oncol 16(11):3048–3056

    Article  PubMed  Google Scholar 

  17. Cho SY, Park SJ, Kim SH, Han SS, Kim YK, Lee KW et al (2010) Survival analysis of intrahepatic cholangiocarcinoma after resection. Ann Surg Oncol 17(7):1823–1830

    Article  PubMed  Google Scholar 

  18. de Jong MC, Nathan H, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H et al (2011) Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 29(23):3140–3145

    Article  PubMed  Google Scholar 

  19. Ariizumi S, Kotera Y, Katagiri S, Nakano M, Nakanuma Y, Saito A, Yamamoto M (2014) Long-term survival of patients with cholangiolocellular carcinoma after curative hepatectomy. Ann Surg Oncol 21(Suppl 3):S451–S458

    Article  PubMed  Google Scholar 

  20. Doussot A, Gonen M, Wiggers JK, Groot-Koerkamp B, DeMatteo RP, Fuks D et al (2016) Recurrence patterns and disease-free survival after resection of Intrahepatic cholangiocarcinoma: preoperative and postoperative prognostic models. J Am Coll Surg 223(3):493–505.e2

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bagante F, Spolverato G, Weiss M, Alexandrescu S, Marques HP, Aldrighetti L et al (2017) Assessment of the lymph node status in patients undergoing liver resection for Intrahepatic cholangiocarcinoma: the New Eighth Edition AJCC Staging System. J Gastrointest Surg 22(1):52–59

    Article  PubMed  Google Scholar 

  22. Zhang XF, Bagante F, Chakedis J, Moris D, Beal EW, Weiss M et al (2017) Perioperative and long-term outcome for intrahepatic cholangiocarcinoma: impact of major versus minor hepatectomy. J Gastrointest Surg 21(11):1841–1850

    Article  PubMed  Google Scholar 

  23. Reames BN, Bagante F, Ejaz A, Spolverato G, Ruzzenente A, Weiss M et al (2017) Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis. HPB (Oxford) 19(10):901–909

    Article  Google Scholar 

  24. Bagante F, Spolverato G, Weiss M, Alexandrescu S, Marques HP, Aldrighetti L et al (2017) Impact of morphological status on long-term outcome among patients undergoing liver surgery for intrahepatic cholangiocarcinoma. Ann Surg Oncol 24(9):2491–2501

    Article  PubMed  Google Scholar 

  25. Yoh T, Seo S, Hatano E, Taura K, Fuji H, Ikeno Y et al (2017) A novel biomarker-based preoperative prognostic grading system for predicting survival after surgery for intrahepatic cholangiocarcinoma. Ann Surg Oncol 24(5):1351–1357

    Article  PubMed  Google Scholar 

  26. Buettner S, Wilson A, Margonis GA, Gani F, Ethun CG, Poultsides GA et al (2016) Assessing trends in palliative surgery for extrahepatic biliary malignancies: a 15-year multicenter study. J Gastrointest Surg 20(8):1444–1452

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetterstraße 55, 79106, Freiburg, Deutschland

    H. P. Neeff, P. A. Holzner, M. Menzel, A. Klock, S. A. Lang, S. Fichtner-Feigl, U. T. Hopt & F. Makowiec

  2. Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Breisacher Straße 115a, 79106, Freiburg, Deutschland

    P. Bronsert

Authors
  1. H. P. Neeff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. A. Holzner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Menzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Bronsert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Klock
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. A. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Fichtner-Feigl
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. U. T. Hopt
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. Makowiec
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. P. Neeff.

Ethics declarations

Interessenkonflikt

H.P. Neeff, P.A. Holzner, M. Menzel, P. Bronsert, A. Klock, S.A. Lang, S. Fichtner-Feigl, U.T. Hopt und F. Makowiec geben an, dass kein Interessenkonflikt besteht.

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

Additional information

Vorläufige Daten wurden 2016 auf dem 133. Kongress der Deutschen Gesellschaft für Chirurgie präsentiert.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Neeff, H.P., Holzner, P.A., Menzel, M. et al. Das intrahepatische Cholangiokarzinom. Chirurg 89, 374–380 (2018). https://doi.org/10.1007/s00104-018-0609-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-018-0609-2

Schlüsselwörter

Keywords

Search

Navigation