Zusammenfassung
Vor Durchführung einer palliativen Tumorresektion müssen die Risiken des Eingriffs (Morbidität, Letalität) gegenüber dem möglichen Nutzen (u. a. rasche und langfristige Beseitigung tumorbedingter Beschwerden) sowie konkurrierende Behandlungsalternativen (Bypassverfahren, Chemo-/Radiotherapie) besonders sorgfältig gegeneinander abgewogen werden. Multimodale Therapiekonzepte haben in den letzten Jahren beachtenswerte Fortschritte verzeichnet und endoskopische sowie interventionelle Verfahren das Repertoire der palliativen Tumortherapie erweitert. Damit muss der Stellenwert einer palliativen Tumorresektion aktuell neu bewertet werden. Die hierfür wichtigsten Kriterien und Studienergebnisse werden in dieser Übersichtsarbeit erörtert. Unter Einbeziehung dieser Erkenntnisse erfährt die palliative Tumorresektion im Kontext eines multimodalen Behandlungskonzeptes bei den meisten gastrointestinalen Tumoren eine zunehmende Renaissance. Inwieweit die hiermit verbundenen Erwartungen sich tatsächlich erfüllen, sollte jedoch mehr als bisher in randomisierten Studien geprüft werden.
Abstract
Before any palliative tumor resection, the morbidity and mortality risks must be carefully weighed against the continued prognosis (including quick and lasting relief of discomfort from the tumor) and alternative strategies such as bypass, chemotherapy, and radiotherapy. Multimodal concepts have seen considerable progress in recent years, and endoscopic and interventional methods have expanded the instrumentarium for palliative tumor therapy. Thus the value of palliative resection must be reassessed. The most important criteria and study results are described here, as they have resulted in increased interest in palliative tumor resection within a multimodal treatment for most gastrointestinal tumors. More studies are needed to learn how much can realistically be expected of these new approaches.
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Beller, S., Schlag, P.M. Hat die palliative Resektion bei gastrointestinalen Tumoren noch einen Stellenwert?. Chirurg 77, 219–226 (2006). https://doi.org/10.1007/s00104-006-1164-9
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DOI: https://doi.org/10.1007/s00104-006-1164-9
Schlüsselwörter
- Gastrointestinale Karzinome
- Palliative Resektion
- Multimodale Therapie
- Bypassverfahren
- Chemoradiotherapie
- Staging-Laparoskopie