Hintergrund: Kurative Therapieverfahren für das hepatozelluläre Karzinom (HCC) sind die Resektion und die Lebertransplantation. Grundlage für die Therapieentscheidung ist bisher die Klassifikation der Barcelona Clinic Liver Cancer Group (BCLC). Methode: Basis dieser Arbeit ist eine selektive Literaturübersicht zur Therapie des HCC. Leitlinien verschiedener Fachgesellschaften wurden einbezogen und aktuelle Arbeiten zu neuen chirurgischen Techniken besonders berücksichtigt. Ergebnisse: Primär resektable HCCs sollen reseziert werden. Für die Resektion kommen alle Patienten in adäquatem Allgemeinzustand ohne Zirrhose oder mit Child-A-Zirrhose ohne ausgeprägte portale Hypertension in Betracht. Hierbei ist von entscheidender Bedeutung, dass über die Möglichkeit der Resektabilität in einem ausgewiesenen Leberzentrum befunden wird. Auf die Leber beschränkte Rezidive können erneut operiert oder für eine Lebertransplantation gelistet werden. Techniken zur erweiterten Leberresektion und laparoskopische Verfahren finden zunehmend Anwendung und müssen weiter evaluiert werden. Schlussfolgerung: Neben der Resektion ist die Lebertransplantation inzwischen eine Standardtherapie für HCCs in Zirrhose. Innerhalb der Mailand-Kriterien können nach der Transplantation 5-Jahres-Überlebensraten von 70-90% erreicht werden. Allerdings erfordern der zunehmende Organmangel und die daraus resultierenden längeren Wartezeiten mit der Gefahr des Tumorprogresses ein Umdenken. So können Patienten, die für eine Transplantation infragekommen, nicht nur zum Bridging bis zur Transplantation reseziert werden, sondern auch, um eine biologische Stratifizierung durchzuführen. Unter engmaschigem Monitoring kann dann erst bei Auftreten eines Rezidivs eine «Rescue»-Transplantation durchgeführt werden. Jedoch werden auch Patienten mit fortgeschritteneren Tumoren, die nicht oder erst zu spät transplantiert werden können, zunehmend mit guten Ergebnissen reseziert. Somit könnten die Kriterien für eine Resektion im Rahmen der BCLC-Klassifikation erweitert werden.

Keywords:
Hepatozelluläres Karzinom, Leber, Leberresektion, Zirrhose, Lebertransplantation
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