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Möglichkeiten der plastischen Chirurgie in der Behandlung von Weichteilsarkomen

Plastic surgery possibilities in the treatment of soft tissue sarcomas

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die onkologiegerechte, weite En-bloc-Resektion mit allseits tumorfreien Resektionsrändern (R0-Resektion) stellt weiterhin die wichtigste Maßnahme in der Behandlung des lokal begrenzten Weichgewebesarkoms dar. Bei lokal sehr weit fortgeschrittenen Tumoren, die wichtige anatomische Strukturen bereits infiltriert haben, ist die Erlangung einer solchen R0-Situation jedoch mit stark belastenden und mutilierenden operativen Eingriffen verbunden, die unter Umständen zu Funktionsverlusten an den betroffenen Extremitäten oder der Rumpfwand führen können. Verschiedene Verfahren aus der plastischen Chirurgie können die Morbidität nach derartigen Eingriffen reduzieren.

Ziel

Ziel ist es, die Möglichkeiten der plastischen Chirurgie in der multimodalen Therapie von Weichgewebesarkompatienten aufzuzeigen und zu verdeutlichen.

Material und Methoden

Der Beitrag basiert auf einer selektven Literaturrecherche und der Auswertung des eigenen Patientenkollektivs.

Ergebnisse

Verschiedene plastisch-chirurgische Verfahren stehen in der kurativen und palliativen Behandlung von Weichgewebesarkompatienten bei Extremitäten- oder Rumpfwandbefall zur Verfügung. Ausgeprägte Weichteildefekte können durch lokale, gestielte oder freie Lappenplastiken gedeckt werden, während Knochendefekte mithilfe freier Knochentransplantate überbrückt werden können. Motorische Ersatzplastiken können nach tumorbedingten Nerven- oder Muskelresektionen die Funktion der betroffenen Extremität wiederherstellen. In palliativen Krankheitsstadien mit exulzerierten Tumoren kann durch eine suffiziente operative Weichgewebedeckung nach Tumordebulking die Lebensqualität betroffener Patienten verbessert werden.

Diskussion

Rekonstruktive plastisch-chirurgische Verfahren vermögen Funktionsverluste und Weichteildefekte zu korrigieren, sodass Amputationen der betroffenen Gliedmaßen vermieden werden oder rumpfwandresezierende Verfahren erst ermöglicht werden. In palliativen Situationen können sie zu einer Verbesserung der Lebensqualität verhelfen.

Abstract

Background

The therapy of choice for locally limited soft tissue sarcomas involves complete surgical resection of the tumor. The goal of surgical therapy is the achievement of negative surgical margins (R0 resection). In locally advanced soft tissue sarcomas that have already infiltrated critical anatomical structures, the achievement of R0 status can be associated with a high surgical morbidity and result in functional impairment of the affected extremities or truncal wall. Plastic surgery can reduce this surgical morbidity by using a variety of modern techniques.

Objective

The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with soft tissue sarcoma.

Material and methods

This article is based on a review of the current literature and evaluation of an in-house patient database.

Results

Several plastic surgery treatment options can be implemented in the curative and palliative therapy of patients with soft tissue sarcoma of the extremities and truncal wall. Large soft tissue defects can be covered by local pedicled or free flaps, whereas bone defects can be reconstructed by free bone transfer. Motor reconstruction surgery can partially restore functional impairment of extremities after nerve or muscle resection. In palliative disease stages soft tissue coverage after surgical debulking of exulcerated tumors can improve the quality of life of affected patients.

Discussion

Reconstructive plastic surgery techniques can restore functional impairments and cover soft tissue defects so that amputation of extremities can be avoided or complete tumor resection from the truncal wall can be made possible. In palliative disease situations plastic surgery can improve the quality of life.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Lehnhardt, K. Harati, O. Goertz, A. Ring und A. Daigeler geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen und Tieren. Soweit der Beitrag personenbezogene Daten enthält, wurde von den Patienten eine zusätzliche Einwilligung nach erfolgter Aufklärung eingeholt.

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Authors and Affiliations

  1. Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgie Zentrum, Operatives Referenzzentrum für Gliedmaßentumoren, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    M. Lehnhardt, K. Harati, O. Goertz, A. Ring & A. Daigeler

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  1. M. Lehnhardt
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  2. K. Harati
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  3. O. Goertz
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  4. A. Ring
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  5. A. Daigeler
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Correspondence to M. Lehnhardt.

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Lehnhardt, M., Harati, K., Goertz, O. et al. Möglichkeiten der plastischen Chirurgie in der Behandlung von Weichteilsarkomen. Onkologe 20, 1103–1112 (2014). https://doi.org/10.1007/s00761-014-2712-4

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  • DOI: https://doi.org/10.1007/s00761-014-2712-4

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