Der Chirurg

, Volume 84, Issue 11, pp 930–936 | Cite as

Multimodale onkologische Therapiekonzepte, Chemotherapie und Immunsuppression

Auswirkungen auf chirurgische Morbidität und Mortalität
Leitthema
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Zusammenfassung

Durch Chemotherapie und moderne zielgerichtete Therapien entstehen bei Patienten mit malignen Tumoren Konditionen, die den postoperativen Verlauf negativ beeinflussen können. Bei Adenokarzinomen des Magens und des ösophagogastralen Überganges spielen kombinierte neoadjuvante Radiochemotherapien eine zunehmende Rolle. Aufgrund zunehmender Metastasenchirurgie beim kolorektalen Karzinom sollten die Spezifika einzelner Therapeutika dem Operateur bekannt sein. Während ungeklärt ist, ob substanzspezifische chemotherapieinduzierte Leberveränderungen das Risiko postoperativer Komplikationen erhöhen, sollte nach Einsatz von Bevacizumab in jedem Fall ein zumindest 5-wöchiger Abstand zur Operation eingehalten werden, um das Risiko für Blutung und Wundheilungsstörung zu minimieren. Auch immunsuppressive und immunmodulatorische Medikamente nehmen Einfluss auf den Wundheilungsprozess und sollten in jedem Fall präoperativ überprüft werden. Für Patienten unter chronischer Steroidtherapie sollten perioperative Anpassungen je nach Ausmaß des Eingriffes und des Substitutionsbedarfes erfolgen.

Schlüsselwörter

Chemotherapie Immunsuppression Nebenwirkungen Chirurgische Morbidität Komplikationen 

Multimodal oncological therapy concepts, chemotherapy and immunosuppressive drugs

Effects on surgical morbidity and mortality

Abstract

Systemic chemotherapy, targeted therapies and radiotherapy for patients with malignant tumors lead to unfavorable surgical conditions with increased risks of postoperative complications. For gastric cancer and cancer of the esophagogastric junction, surgery after neoadjuvant treatment is associated with a mortality of approximately 5 %. Given the increase in metastatic surgery for colorectal carcinoma, surgeons should be aware of the specific side effects of therapeutic drugs to ensure an optimal course of treatment. The impact of chemotherapy-induced hepatic lesions on postoperative development is unclear. Bevacizumab treatment should be stopped at least 5 weeks before surgery to reduce the risk of thromboembolic events, bleeding and wound healing complications. Immunosuppressive and immunomodulating agents alter wound healing and preoperative alterations should be carefully evaluated. For patients with chronic corticosteroid therapy, perioperative supplementation should be considered when planning surgery as well as routine dosages

Keywords

Chemotherapy Immunosuppression Adverse effects Surgical morbidity Complications 
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Notes

Danksagung

Wir bedanken uns bei Mareike Dietrich für das freundliche Überlassen der Fotographie.

Einhaltung ethischer Richtlinien

Interessenkonflikt. A.K. Berger und D. Jäger geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Medizinische OnkologieNationales Centrum für Tumorerkrankungen HeidelbergHeidelbergDeutschland

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