Die kombinierte leber- und pankreaskopfresektion zur behandlung des fortgeschrittenen zentralen gallengangskarzinoms

In order to increase the resection-rate of advanced stages of bile duct carcinoma a therapeutic concept has been designed that includes right side trisegmentectomy, resection of all extrahepatic bile ducts, regional lymphadenectomy together with resection of the head of the pancreas taking into consideration bile duct anatomy but also growth pattern of this tumor type. We have applied this concept in 6 patients (4 Bismuth type III, 2 Bismuth type IV). In five of the three male and three female patients a R0-resection was achieved. In two cases, however, the portal vein and in one patient the proper hepatic artery had to be resected as well. All three patients who had preoperative external or internal bile duct drainage developed septic complications after surgery. Apart from a bleeding from the pancreatic transection surface due to anticoagulation requiring open repair a right side pleural effusion had to be drained in 4 patients. Even if there was no hospital mortality, only one patient survived disease free long-term. From this limited experience it is concluded, that this complex type of surgery is feasable, but without effective additive therapy cure can be achieved only in individual cases.