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Systematische Chirurgie retroperitonealer Sarkome

Bildgestützte Planung des Resektionsausmaßes

Systematic surgery of retroperitoneal sarcomas

Imaging-guided planning of surgical strategy

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Zusammenfassung

Abdominelle und retroperitoneale Sarkome stellen ca. 25–30 % aller Weichteilsarkome dar, zählt man neben klassischen retroperitonealen Tumoren auch gastrointestinale Stromasarkome (GIST) hinzu. Die chirurgische R0-En-bloc-Resektion ist grundsätzlich das einzige potenziell kurative Therapieverfahren. Bei der Wahl der richtigen Operationsstrategie spielen insbesondere die histopathologische Subentität und Lokalisation eine zentrale Rolle. Ziel bei der Wahl des chirurgischen Resektionsausmaßes sollte möglichst die chirurgische En-bloc-Resektion des Tumors mit negativen Resektionsrändern sein, was aufgrund der häufig großen Tumoren und den engen anatomischen Lagebeziehungen zu vitalen Strukturen nicht immer erreichbar ist. Trotz der Einführung multimodaler Therapieverfahren und der Entwicklung standardisierter erweiterter Operationsverfahren (systematische kompartimentelle Resektionen, SRKR) sind Lokalrezidive für die meisten tumorbedingten Todesfälle ursächlich. Nicht zuletzt die Ergebnisse der Transatlantic RPS Working Group konnten zeigen, dass die Behandlung in High-volume-Zentren zu einer Steigerung des Überlebens beiträgt. Insbesondere in Deutschland besteht nach wie vor großer Nachholbedarf bei der Zentralisierung der Versorgung von Sarkompatienten.

Abstract

Abdominal and retroperitoneal sarcomas (RPS) represent approximately 25–30% of all soft tissue sarcomas, if besides typical retroperitoneal tumors gastrointestinal stromal tumors (GIST) are also included. The surgical R0 en bloc resection with histopathologically free margins is basically the only potentially curative treatment procedure. When planning the surgical strategy, the histopathological subtype and tumor localization are pivotal. The extent of resection should be guided by the goal to reach an en bloc resection with histopathologically negative margins. Due to the frequently found vast dimensions of RPS and ultimately topographic proximity to vital structures at primary diagnosis, R0 resections are not always achievable. Despite the introduction of multimodal treatment regimens and the development of standardized extended surgical procedures, such as systematic retroperitoneal compartmental resection (SRCR), local recurrences remain the most common cause of tumor-associated death. Finally, the results of the transatlantic RPS working group (TARPSWG) could show that treatment of RPS in specialized high-volume centers contributes to better long-term survival. Particularly in Germany there is an urgent demand for centralization of sarcoma patient treatment.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    M. Ghadimi &  C. J. Bruns

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  1. M. Ghadimi
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  2. C. J. Bruns
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Correspondence to M. Ghadimi.

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Interessenkonflikt

M. Ghadimi und C. Bruns geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Ghadimi, M., Bruns, C.J. Systematische Chirurgie retroperitonealer Sarkome. Chirurg 90, 447–456 (2019). https://doi.org/10.1007/s00104-019-0952-y

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