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Gallbladder cancer – only surgery is curative

Das Gallenblasenkarzinom – Nur die Chirurgie ermöglicht eine Heilung

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Zusammenfassung

GRUNDLAGEN: Das Gallenblasenkarzinom (GBC) ist ein seltenes Karzinom, welches eine höhere Inzidenz bei Frauen als bei Männern hat. Das GBC hat zumeist eine schlechte Prognose. METHODIK: Es wird eine Übersicht über die Literatur und aktuelle therapeutische Konzepte gegeben. ERGEBNISSE: In der Karzinomentstehung scheint die chronische Entzündung und die Dysplasie eine größere Bedeutung zu haben als das Adenom. Der Ultraschall und das CT sind für die Evaluierung der lokalen Tumorextension sehr effektiv. Die Resektion ist die einzige kurative therapeutische Option beim GBC. Die Cholezystektomie ist die adäquate Therapie für T1-GBC. Im Falle von T2-Tumoren ist eine Leberresektion im Bereich des Gallenblasenbettes mit zumindest 2 cm Abstand und eine Lymphadenektomie wie bei T3/T4 erforderlich. Bei T3-Tumoren sollte der Leberresektionsrand zumindest 3 cm sein, und bei T4-Tumoren ist eine zusätzliche Resektion der extrahepatischen Gallenwege erforderlich. Die konservativen onkologischen Optionen für das GBC werden kontroversiell diskutiert. SCHLUSSFOLGERUNGEN: Eine frühe Tumordiagnose und eine radikale Resektion sind die einzigen Parameter, welche eine Heilung bei Patienten mit GBC ermöglichen, aber es ist nur bei einer geringen Patientenanzahl möglich.

Summary

BACKGROUND: Gallbladder cancer (GBC) is a rare malignancy which has a higher incidence in female than in male patients. GBC has usually a poor prognosis. METHODS: Review of literature and current therapeutic concepts. RESULTS: In the carcinogenesis of GBC chronic inflammation and dysplasia seem to be more important than adenoma. For the evaluation of the local tumor extension ultrasound and CT scan are most effective. Resection offers the only curative therapeutic option in GBC. Cholecystectomy is the adequate therapy for T1 GBC. In case of T2 tumors liver resection of the gallbladder bed with a parenchymal edge of at least 2 cm and lymphadenectomy like in T3/T4 are required. For T3 tumors the edge of resected liver parenchyma should be at least 3 cm and for T4 tumors an additional extrahepatic bile duct resection is necessary. Conservative oncological therapeutic options for GBC are discussed controversially. CONCLUSIONS: Early tumor detection and radical resection are the only parameters to cure GBC but it is just possible in a small number of patients.

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  1. Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria

    H. Puhalla & F. Laengle

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  1. H. Puhalla
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  2. F. Laengle
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Correspondence to H. Puhalla.

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Puhalla, H., Laengle, F. Gallbladder cancer – only surgery is curative. Eur Surg 38, 100–106 (2006). https://doi.org/10.1007/s10353-006-0228-x

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