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Intraoperative Chemotherapie nach radikaler Pleurektomie oder extrapleuraler Pneumonektomie

Intraoperative chemotherapy after radical pleurectomy or extrapleural pneumonectomy

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Zusammenfassung

Durch eine trimodale Behandlungsstrategie bestehend aus neoadjuvanter bzw. adjuvanter Chemotherapie, radikaler Operation und ggf. Strahlentherapie kann bei ausgewählten Patienten mit malignen Pleuratumoren (malignes Pleuramesotheliom, Thymome mit pleuraler Aussaat) eine potenziell kurative Therapie verfolgt werden. Das lokale Tumorrezidiv im Thorax limitiert jedoch weiterhin sowohl das Langzeitüberleben als auch die Lebensqualität der betroffenen Patienten. Aus diesem Grund wird zur Verbesserung der lokalen Tumorkontrolle seit einigen Jahren eine zusätzliche intraoperative Chemotherapie durchgeführt. Voraussetzung ist eine möglichst komplette makroskopische Tumorresektion, welche entweder durch eine radikale Pleurektomie oder eine extrapleurale Pneumonektomie erzielt werden kann. In diesem Beitrag werden das Konzept und das perioperative Management dieses additiven Therapiekonzeptes vorgestellt und die internationale Literatur diskutiert.

Abstract

Trimodality treatment including induction and/or adjuvant chemotherapy, surgical resection and in some cases radiotherapy offers a curative intention in selected patients with pleural malignancies (malignant pleural mesothelioma, thymoma with pleural spread). Nevertheless, locoregional tumor recurrence mainly limits the outcome and the quality of life. A few years ago an additional intraoperative chemotherapy perfusion was developed in order to improve local tumor control and prognosis after surgical resection in a multimodality treatment setting. Cytoreductive surgery with the purpose of a macroscopic complete resection could be achieved by radical pleurectomy or extrapleural pneumonectomy. The concept, techniques and perioperative management of this additional treatment option are presented along with a detailed review of the recent literature.

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  1. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    M. Ried & H.-S. Hofmann

  2. Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland

    H.-S. Hofmann

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  1. M. Ried
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  2. H.-S. Hofmann
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Correspondence to M. Ried.

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Ried, M., Hofmann, HS. Intraoperative Chemotherapie nach radikaler Pleurektomie oder extrapleuraler Pneumonektomie. Chirurg 84, 492–496 (2013). https://doi.org/10.1007/s00104-012-2433-4

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  • DOI: https://doi.org/10.1007/s00104-012-2433-4

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