Klatskinov tumor kao moguća indikacija za transplantaciju jetre

master's thesis

• Title (english): Klatskin's tumor as a possible indication for liver transplants
• Author: Lucija Ermacora
• Mentor: Stipislav Jadrijević (mentor)
• Committee member: MATE ŠKEGRO (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Stipislav Jadrijević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Klatskinov tumor (ili hilarni kolangiokarcinom) je ekstrahepatalni kolangiokarcinom koji nastaje na spoju lijevog i desnog hepatalnog žučnog voda. Kolangiokarcinomi su rijetke zloćudne neoplazme te na njih otpada samo 3% svih gastrointestinalnih maligniteta. Upravo je hilarni kolangiokarcinom među njima najzastupljeniji (50%), dok se distalni i intrahepatalni pojavljuju u manjem broju slučajeva. Klatskinov je tumor bolest uznapredovale životne dobi koja se tipično prezentira u pacijenata... More starijih od 60 godina. Iznimku pojavljivanja u kasnijoj životnoj dobi čine pacijenti sa primarnim sklerozirajućim kolangitisom. U njih se neoplazma javlja ranije, tipično unutar 2,5 godine od postavljanja dijagnoze. Osim primarnog sklerozirajućeg kolangitisa u literaturi se kao rizični čimbenici navode i: hepatolitijaza, staza žuči, rekurentni subklinički kolangitis, parazitarne infekcije i kongenitalne anomalije bilijarnog stabla. U većine je pacijenata bolest dugo vremena asimptomatska, a ako postoje simptomi su nespecifični i uključuju ikterus, svijetlu stolicu, taman urin, pruritus i gubitak težine. Dijagnostička obrada trebala bi se temeljiti na radiološkim pretragama abdomena CT-om ili MR-om za procjenu vaskularne invazije i prikaz bilijarnog stabla. Nadalje, potreban je i CT toraksa radi isključivanja metastatske bolesti te laboratorijski nalaz testova jetrene funkcije i tumorskih markera CA 19-9 i CEA. Danas se u svijetu najčešće koriste 3 klasifikacijska sustava: Bismuth-Corlette sustav, MSKCC klasifikacija i TNM klasifikacija. Kirurško liječenje jedini je terapijski modalitet koji pacijentima daje šansu za dugoročno preživljenje. U ovisnosti o lokalizaciji i tipu tumora kirurški zahvat može uključivati lokalnu eksciziju, agresivnu resekciju ili transplantaciju jetre. Transplantacija jetre relativno je nova potencijalna terapijska metoda za pacijente u kojih tumor nije resektabilan. Striktna selekcija bolesnika i preoperativna primjena neoadjuvantne terapije po protokolu Mayo klinike daju nadu u moguće ozdravljenje i poboljšanje ishoda liječenja u navedenih pacijenata. Less

Abstract (english)

Klatskin’s tumor (or hilar cholangiocarcinoma) is an extra-hepatic cholangiocarcinoma arising in the junction of the main right and left hepatic bile ducts. Cholangiocarcinoma is a rare malignant neoplasm and accounts for only 3% of gastrointestinal tumours. Hilar cholangiocarcinoma is most common among them (50%), while distal and intrahepatic occur in fewer cases. Klatskin's tumor usually occurs at older age and it’s typically reported in patients older than 60 years. An exeption of... More the age of occurrence is found in patients with primary sclerosing cholangitis. In this group neoplasms occur earlier, typically within 2.5 years of diagnosis. In addition to the primary sclerosing cholangitis, there are several established risk factors including hepatolytosis, bile stasis, recurrent subclinical cholangitis, parasitic infections, and congenital anomalies of the biliary tract. In most patients, the disease is asymptomatic for a long time and if the symptoms occur they are non-specific and include icterus, light stool, dark urine, pruritus and weight loss. Techniques used to diagnose Klatskin’s tumor include abdominal imaging by computed tomography (CT) or magnetic resonance imaging (MRI) to assess for vascular invasion and provide noninvasive cholangiography. Furthermore, chest CT is obtained to exclude metastatic disease as well as laboratory testing including liver function tests and tumor markers CA 19-9 and CEA. The three systems most commonly used to evaluate hilar cholangiocarcinoma are the Bismuth-Corlette system, the MSKCC and the TNM classification. Surgical treatment is the only therapeutic modality that gives patients a chance for long-term survival. Depending on localization and type of tumor, surgical procedure may include local excision, aggressive resection or liver transplantation. Liver transplantation is a relatively new potential therapeutic method for patients with unresectable disease. Strict patient selection and preoperative neoadjuvant therapy following the Mayo Clinic protocol provide hope for possible recovery and outcome improvement in selected patients. Less

• Keywords: Klatskinov tumor; hilarni kolangiokarcinom; transplantacija jetre
• Keywords (english): Klatskin’s tumor; hilar cholangiocarcinoma; liver transplantation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:370224
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-02-26 11:36:12