[Surgical treatment for hilar cholangiocarcinoma (Klatskin's tumor)]
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[Surgical treatment for hilar cholangiocarcinoma (Klatskin's tumor)]. / Becker, T; Lehner, F; Bektas, H; Meyer, A; Lück, R; Nashan, Björn; Klempnauer, J.
In: ZBL CHIR, Vol. 128, No. 11, 11, 2003, p. 928-935.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - [Surgical treatment for hilar cholangiocarcinoma (Klatskin's tumor)]
AU - Becker, T
AU - Lehner, F
AU - Bektas, H
AU - Meyer, A
AU - Lück, R
AU - Nashan, Björn
AU - Klempnauer, J
PY - 2003
Y1 - 2003
N2 - Surgical treatment of hilar bile duct carcinoma remains difficult, which is due to the inadequate possibilities in assessing tumor extent during the preoperative diagnostic procedure as well as intraoperatively. Radical resection with negative histologic margins offers the best chance for long-term survival. The decision regarding the appropriate surgical approach is challenging due to the complexity of tumor localization and neighboring vascular structures. Aggressive resection demands extended liver resection, which is associated with the risk of postoperative liver failure. However, even limited surgery such as hilar resection can be curative and leads to long-term survival in individual cases. The principles of surgical oncology have led to more aggressive procedures, including the combination of liver transplantation and multivisceral resection, and can be performed with calculable morbidity and mortality. Nevertheless, the high risk of tumor recurrence under long-term immunosuppression, the limited availability of donor organs and the excellent results of liver transplantation in non-malignant diseases do not justify this procedure at present. Neoadjuvant radiochemotherapy has failed to demonstrate major benefit. In patients with irresectable tumor or distant metastases palliative measures are aimed at restoring an unobstructed bile flow with endoscopic placement of metal stents. Palliative treatment with additional radio- or photodynamic therapy may be considered in individual cases.
AB - Surgical treatment of hilar bile duct carcinoma remains difficult, which is due to the inadequate possibilities in assessing tumor extent during the preoperative diagnostic procedure as well as intraoperatively. Radical resection with negative histologic margins offers the best chance for long-term survival. The decision regarding the appropriate surgical approach is challenging due to the complexity of tumor localization and neighboring vascular structures. Aggressive resection demands extended liver resection, which is associated with the risk of postoperative liver failure. However, even limited surgery such as hilar resection can be curative and leads to long-term survival in individual cases. The principles of surgical oncology have led to more aggressive procedures, including the combination of liver transplantation and multivisceral resection, and can be performed with calculable morbidity and mortality. Nevertheless, the high risk of tumor recurrence under long-term immunosuppression, the limited availability of donor organs and the excellent results of liver transplantation in non-malignant diseases do not justify this procedure at present. Neoadjuvant radiochemotherapy has failed to demonstrate major benefit. In patients with irresectable tumor or distant metastases palliative measures are aimed at restoring an unobstructed bile flow with endoscopic placement of metal stents. Palliative treatment with additional radio- or photodynamic therapy may be considered in individual cases.
M3 - SCORING: Zeitschriftenaufsatz
VL - 128
SP - 928
EP - 935
JO - ZBL CHIR
JF - ZBL CHIR
SN - 0044-409X
IS - 11
M1 - 11
ER -