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Metastasiertes Kolonkarzinom

Wann besteht keine Indikation zur primären Resektion?

Metastasized colonic cancer

When are there no indications for primary resection?

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Zusammenfassung

Die Festlegung eines optimalen Behandlungskonzeptes für Patienten mit Kolonkarzinomen bei gleichzeitig inkurabler Situation aufgrund einer simultanen Fernmetastasierung bleibt eine Herausforderung. Das gilt insbesondere dann, wenn der Primärtumor asymptomatisch ist. Die Datenlage zu Nutzen oder Patientengefährdung durch die Primärtumorresektion in dieser Konstellation ist begrenzt und uneinheitlich. Ein Überlebensvorteil der Resektion im Vergleich zur primären Chemotherapie konnte bisher nur in retrospektiven Analysen mit einem Bias zuungunsten der primären Chemotherapiegruppen aufgezeigt werden. Die wichtige Frage der Lebensqualität wird diesbezüglich gar nicht abgebildet. Es gibt zahlreiche Arbeitsgruppen und auch aktuelle Leitlinien, die mit plausiblen Argumenten eine primär palliativ systemische Chemotherapie, ggf. erweitert um die Gabe von Antikörpern, für diese Patientenklientel favorisieren. Die Ergebnisse der aktuell laufenden prospektiv randomisierten multizentrischen SYNCHRONUS-Studie werden uns helfen, unsere Entscheidungen bezüglich der Indikationsstellung zur Primärtumorresektion oder zur primären Chemotherapie auf eine objektive Basis zu stellen.

Abstract

The determination of an optimal treatment protocol for colonic cancer with synchronous incurable metastases remains a challenge, especially if the primary tumor is asymptomatic. Available data on whether resection of the primary tumor means a benefit or a danger to the patient are limited and inhomogeneous. A survival benefit could be shown only in retrospective studies with a bias against primary chemotherapy. The important question of the quality of life (QOL) remains completely unanswered in this respect. There are numerous groups and guidelines in favor of a primary palliative chemotherapy for these patients, possibly intensified by antibodies. The results of the currently ongoing randomized multicenter SYNCHRONUS study will deliver objective data facilitating the decision-making process with respect to the indications for resection of the primary tumor or primary chemotherapy.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Kube und P. Mroczkowski geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Chirurgie, Carl-Thiem-Klinikum Cottbus, Thiemstr. 111, 03048, Cottbus, Deutschland

    R. Kube

  2. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland

    P. Mroczkowski

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Kube, R., Mroczkowski, P. Metastasiertes Kolonkarzinom. Chirurg 86, 148–153 (2015). https://doi.org/10.1007/s00104-014-2765-3

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