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Komplexe Becken- und Sarkomchirurgie mit Gefäßersatz

Complex pelvic and sarcoma surgery with vascular replacement

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Zusammenfassung

Durch die Optimierung der onko- und gefäßchirurgischen Operationstechnik, modernste anästhesiologische und intensivtherapeutische Verfahren sowie effektivere multimodale Therapien ist eine zunehmende Erweiterung der Indikationsstellungen für komplexe Resektionen bei Patienten mit lokal weit fortgeschrittenen malignen Tumoren und damit die Aussicht auf Heilung möglich geworden. Ausgedehnte Malignome mit Infiltration von Gefäßen vitaler Relevanz oder solchen, die für den Extremitätenerhalt unabdingbar sind, bzw. maligne Tumoren dieser Gefäße selbst stellen jedoch aus mehreren Gründen eine erhebliche Herausforderung für die Expertise des Chirurgen und einen signifikanten Morbiditätsfaktor für die Patienten dar. Die Indikationsstellung sollte immer im gesamtonkologischen Kontext erfolgen. Bei der Operationsplanung und -durchführung sowie im postoperativen Verlauf ist deshalb große chirurgische und interdisziplinäre Erfahrung, insbesondere auch beim Management etwaiger Komplikationen essenziell. Im Folgenden sollen daher wichtige Aspekte der Indikationsstellung und Operationsdurchführung, onkologische Ergebnisse sowie Daten zur Morbidität und Mortalität bei relevanten Tumorentitäten des Retroperitoneums und des kleinen Beckens dargestellt und anhand von Beispielen erläutert werden.

Abstract

Due to optimization of surgical techniques in surgical oncology and vascular surgery, the most modern approaches of anesthesia and intensive care medicine and effective multimodal therapeutic strategies, locally advanced malignant tumors are resected more frequently with a potentially curative intent. In the case of extensive tumors with infiltration of vital vascular structures or of structures which are crucial for extremity preservation, the necessary surgical procedure for complete tumor removal poses a major challenge for the surgeon and incorporates a high risk of perioperative morbidity for the patient. The decision to attempt tumor resection should therefore always be based on a concept considering all aspects of the malignant disease. The treating team should be highly experienced in this complex field of surgery, not only with respect to the surgical approach but also regarding the management of postoperative complications. In this article relevant aspects of decision making, surgical technique and postoperative outcome for malignant tumors involving vascular structures of the retroperitoneum and pelvis are presented.

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Authors and Affiliations

  1. Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    S. Pistorius,  Ch. Reeps &  J. Weitz

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  1. S. Pistorius
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  2. Ch. Reeps
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  3. J. Weitz
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Correspondence to S. Pistorius.

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S. Pistorius, C. Reeps und J. Weitz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Pistorius, S., Reeps, C. & Weitz, J. Komplexe Becken- und Sarkomchirurgie mit Gefäßersatz. Chirurg 87, 108–113 (2016). https://doi.org/10.1007/s00104-015-0123-8

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