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Peritonealkarzinose kolorektalen Ursprungs

Ergebnisse der zytoreduktiven Chirurgie mit Peritonektomie und hyperthermer intraoperativer Chemotherapie

Peritoneal carcinomatosis of colorectal origin

Results of cytoreductive surgery with peritonectomy and hyperthermic intraoperative chemotherapy

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Zusammenfassung

Während bis vor wenigen Jahren eine Peritonealkarzinose (PK) ausgehend von einem kolorektalen Karzinom (KRK) generell als terminale Krankheitsmanifestation angesehen wurde und die Patienten trotz palliativer systemischer Chemotherapie (CHT) innerhalb weniger Monate verstarben, existiert heute mit der zytoreduktiven Chirurgie (CRS) des Bauchraums und der hyperthermen intraperitonealen CHT in Kombination mit einer perioperativen systemischen CHT ein Behandlungskonzept, das bei selektionierten Patienten zu einer deutlichen Lebenszeitverlängerung führen kann. In der vorliegenden Studie haben wir die prospektiv erhobenen Daten von 30 konsekutiv mit diesem Behandlungsregime therapierten Patienten ausgewertet. Bei einer medianen Nachbeobachtungszeit von 16,9 Monaten betrug das mediane Überleben für das Gesamtkollektiv 24,3 Monate. Prognostisch vorteilhafte Faktoren sind eine geringe intraperitoneale Tumormanifestation, erkennbar an einem niedrigen Peritonealkarzinoseindex (medianes Überleben PCI ≤ 10: 33,2 Monate vs. PCI 11–19: 12,1 Monate), bzw. eine vollständige oder nahezu vollständige CRS (medianes Überleben CCR 0/1: 33,1 Monate vs. CCR2/3: 12,1 Monate). Das 2-Jahres-Gesamtüberleben beträgt bei einem PCI ≤ 10 89% und nach einer chirurgischen CCR0/1-Zytoreduktion 65%. Da nicht jeder Patient mit einem KRK und PK von diesem aggressiven Therapiekonzept profitiert, ist eine interdisziplinäre Patientenselektion (Tumorboard) und Behandlung in erfahrenen chirurgisch-onkologischen Zentren sinnvoll.

Abstract

Until recently peritoneal carcinomatosis (PC) arising from colorectal cancer (CRC) was considered to be a terminal disease manifestation. Despite palliative systemic chemotherapy (CHT) the majority of patients died within a few months. Nowadays cytoreductive surgery (CRS) of the peritoneal cavity in combination with hyperthermic intraperitoneal CHT and perioperative systemic CHT may offer a chance for long-term survival in selected groups of patients. In this study we report the results obtained with this treatment strategy in 30 consecutive patients. Data were assessed prospectively. After a median follow-up of 16.9 months the median survival time in all 30 patients reached 24.3 months. Favorable prognostic factors are a low extent of intraperitoneal metastases as characterized by a low peritoneal cancer index (median survival PCI ≤ 10: 33.2 months vs. PCI 11–19: 12.1 months) and a complete or nearly complete CRS (median survival CCR 0/1: 33.1 months vs. CCR2/3: 12.1 months). The 2-year overall survival was 89% for patients with a PCI ≤ 10 and 65% for those with surgical CCR 0/1 cytoreduction. As not every patient with CRC and PC may profit from this relatively aggressive therapy an interdisciplinary patient selection (tumor board) and treatment in experienced surgical oncology centers is recommended.

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  1. Chirurgisches Zentrum und Asklepios Tumorzentrum, Asklepios Paulinenklinik, Geisenheimer Str. 10, 65197, Wiesbaden, Deutschland

    T. Weber, M. Roitman & K.H. Link

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  1. T. Weber
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  2. M. Roitman
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Correspondence to T. Weber.

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Weber, T., Roitman, M. & Link, K. Peritonealkarzinose kolorektalen Ursprungs. Chirurg 84, 130–139 (2013). https://doi.org/10.1007/s00104-012-2419-2

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