Chirurgische Strategie beim Karzinom der Gallenblase und der extrahepatischen Gallenwege

Abstract

The treatment of malignancies of the gallbladder and the extrahepatic biliary tract by surgical resection is still the only curative treatment option of this rare and problematic tumor entity today. Due to the rare early diagnosis and the close site to complex adjoining structures, only a minority of patients is resectable in a curative manner. In selected patients an adequate surgical therapy can improve prognostic survival chances combined with an acceptable perioperative morbidity. In surgical strategies, obtaining tumor-free resection margins is most relevant. The basic surgical policy with curative intention in gallbladder carcinomas is the conventional en-bloc resection of the gallbladder and the cystic duct enclosing liver tissue adjoining the gallbladder bed and the lymph nodes at the cystic duct, the hepatoduodenal ligament, and the suprapancreatic tissue. In carcinomas of the extrahepatic bile duct, the complete resection of extrahepatic bile ducts with closure in its suprapancreatic segment plus en-bloc removal of all adjacent lymphatic tissues of the hepatoduodenal ligament is the basis of all surgical strategies with curative objective. In individual cases supplementary multivisceral resection or ultra-radical procedures provide a chance for prognostic improvements.