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Neoadjuvante Therapie bei Tumoren des oberen Gastrointestinaltrakts

Komplikationsmanagement

Neoadjuvant therapy for tumors of the upper gastrointestinal tract

Complication management

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Zusammenfassung

Neue Studien konnten zeigen, dass die neoadjuvante Chemotherapie bzw. Radiochemotherapie beim Ösophagus- und Magenkarzinom das Risiko der postoperativen Morbidität und Letalität, verglichen mit der alleinigen Chirurgie, nicht signifikant erhöht. Für die Patientensicherheit und Wirksamkeit einer neoadjuvanten Behandlung spielt die qualitätsgesicherte Durchführung jeder einzelnen Therapiemodalität und darüber hinaus die enge und professionelle Zusammenarbeit der Disziplinen eine entscheidende Rolle. Ein Großteil der möglichen Nebenwirkungen und Komplikationen, die während einer neoadjuvanten Therapie auftreten können, lassen sich durch eine sachgerechte Prophylaxe und ein professionelles Komplikationsmanagement ausreichend kontrollieren. Komplikationen vor, während und nach neoadjuvanter Therapie von Tumoren des oberen Gastrointestinaltrakts können auch durch den Tumor selbst oder durch die Therapie hervorgerufen werden. Diese umfassen Blutungen, Fisteln, Perforationen und Stenosen. Moderne endoskopische Techniken stellen hier die Therapie der Wahl dar. Die präoperative Konditionierung während des Zeitraums der neoadjuvanten Therapie eröffnet die Möglichkeit der Reduktion postoperativer Komplikationen.

Abstract

Recent studies could demonstrate that neoadjuvant chemotherapy and radiochemotherapy for esophageal and gastric cancer do not significantly increase the risk of postoperative morbidity and mortality as compared to surgery alone. With respect to patient safety and effectiveness of neoadjuvant concepts, quality assured performance of each treatment modality and close interdisciplinary cooperation play an important role. The majority of potential side effects and complications, which might occur during neoadjuvant therapy can be adequately controlled by correct prophylaxis and professional medical complication management. Complications before, during and after neoadjuvant therapy of upper gastrointestinal tract tumors can also be caused by the tumor itself or by medicinal therapy. These comprise bleeding, fistulas, perforations and stenoses. Modern endoscopic techniques are the therapy of choice in these situations. Preoperative conditioning during the period of neoadjuvant therapy opens the possibility of reduced postoperative complications to patients with tumors of the upper gastrointestinal tract.

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Author information

Authors and Affiliations

  1. Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    I. Gockel MBA

  2. Klinik für Gastroenterologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    A. Hoffmeister

  3. Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    F. Lordick

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  1. I. Gockel MBA
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  2. A. Hoffmeister
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  3. F. Lordick
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Correspondence to I. Gockel MBA.

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Interessenkonflikt

I. Gockel, A. Hoffmeister und F. Lordickgeben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Gockel, I., Hoffmeister, A. & Lordick, F. Neoadjuvante Therapie bei Tumoren des oberen Gastrointestinaltrakts. Chirurg 86, 1014–1022 (2015). https://doi.org/10.1007/s00104-015-0077-x

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