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Therapeutische Strategien bei lokoregionalen Rezidiven gastrointestinaler Tumoren

Palliation oder Kuration?

Curative vs palliative strategies in locoregional recurrence of gastrointestinal malignancies

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Zusammenfassung

Lokoregionale Rezidive stellen ein relevantes Problem in der chirurgischen Onkologie dar. Intraluminale Lokalrezidive sind in vielen Fällen Ausdruck einer unzureichenden Primärresektion, die mit nicht ausreichenden Sicherheitsabständen durchgeführt wurde. Die Nachresektion mit ausreichenden Sicherheitsabständen stellt, wann immer möglich, das Therapieverfahren der Wahl dar. Das Auftreten eines Rezidivs im Tumorbett ist nach optimaler primärer Resektion Ausdruck einer bereits primär lokal weit fortgeschrittenen Erkrankung. Die Indikation zur Nachresektion ist hier immer sehr kritisch abzuwägen. Aussicht auf längerfristige Tumorkontrolle besteht nur, wenn die Zweitresektion residualtumorfrei durchgeführt werden kann und wenn sie sinnvoll in ein multimodales Behandlungskonzept eingebettet ist. Für Rezidive im Bereich der Lymphabstrombahn, der sog. 4. Dimension, besteht in der Regel keine zweite kurative Behandlungsoption.

Abstract

Locoregional recurrence is a relevant problem in surgical oncology. Intraluminal local relapse only occurs when the primary resection is carried through with inappropriate safety margins. If possible, a second surgical resection with wider margins is the treatment of choice. When the primary resection was appropriately done, extraluminal relapse in the original tumor bed indicates the primary tumor was already in an advanced stage. The indication for a second resection must be considered carefully. A realistic prospect of long-term tumor control exists only when the second resection yields tumor-free margins and is combined with chemo- and radiotherapy. There is usually no curative treatment option for recurrences in the draining lymph node region, the so-called fourth dimension.

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Authors and Affiliations

  1. Chirurgische Klinik Klinikum rechts der Isar, Technische Universität München

    F. Lordick, K. Ott, B. L. D. M. Brücher & R. Rosenberg

  2. Chirurgische Klinik Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , München

    J. R. Siewert

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  1. J. R. Siewert
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  2. F. Lordick
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  3. K. Ott
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  4. B. L. D. M. Brücher
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  5. R. Rosenberg
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Correspondence to J. R. Siewert.

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Siewert, J.R., Lordick, F., Ott, K. et al. Therapeutische Strategien bei lokoregionalen Rezidiven gastrointestinaler Tumoren. Chirurg 77, 227–235 (2006). https://doi.org/10.1007/s00104-006-1163-x

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