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PIPAC und HIPEC – konkurrierende oder ergänzende Therapieverfahren bei peritonealen Metastasen

PIPAC and HIPEC—competing or supplementary therapeutic procedures for peritoneal metastases

Der Chirurg volume 89, pages 693–698 (2018)Cite this article

Zusammenfassung

Die Therapie der Peritonealkarzinose ist nach wie vor eine Herausforderung. Aktuell bietet nur die Kombination aus zytoreduktiver Chirurgie („cytoreductive surgery“, CRS) und hyperthermer intraperitonealer Chemotherapie (HIPEC) einen potenziell kurativen Therapieansatz. Prognostisch entscheidend ist eine vollständige makroskopische Zytoreduktion. Diese erfordert meist eine komplexe Operation mit hoher Morbidität und Mortalität. Das multimodale Verfahren eignet sich deshalb nur für wenige, hoch selektionierte Patienten. Die intraperitoneale Druckaerosolchemotherapie („pressurized intraperitoneal aerosol chemotherapy“, PIPAC) ist ein relativ neues minimal-invasives Verfahren, dessen Wertigkeit und Einsatzspektrum noch nicht abschließend geklärt ist. Die bislang publizierten Arbeiten zeigen jedoch ermutigende Ergebnisse. PIPAC ist damit eine mögliche palliative Therapieoption für Patienten, die sich nicht für CRS und HIPEC eignen. Diese Übersicht fasst die aktuell verfügbare Datenlage bezüglich CRS-HIPEC und PIPAC zusammen.

Abstract

Peritoneal carcinomatosis remains a therapeutic challenge. The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is currently the only potentially curative option with good results. For good oncological results a complete macroscopic cytoreduction is essential. This mostly requires a complex operative procedure with significant morbidity and mortality. Therefore, multimodal treatment is limited to a few highly selected patients. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new minimally invasive approach, the value and spectrum of applications of which are still under investigation; however, the articles on PIPAC published so far are encouraging and PIPAC is therefore a possible palliative therapy option for patients who are not eligible for CRS and HIPEC. The aim of this review is to present a summary of the recent data regarding CRS-HIPEC and PIPAC.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Barmherzige Brüder, Prüfeninger Straße 86, 93049, Regensburg, Deutschland

    H. Leebmann &  P. Piso

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  1. H. Leebmann
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  2. P. Piso
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Correspondence to P. Piso.

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H. Leebmann und P. Piso geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Leebmann, H., Piso, P. PIPAC und HIPEC – konkurrierende oder ergänzende Therapieverfahren bei peritonealen Metastasen. Chirurg 89, 693–698 (2018). https://doi.org/10.1007/s00104-018-0666-6

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  • DOI: https://doi.org/10.1007/s00104-018-0666-6

Schlüsselwörter

  • Peritonealkarzinose
  • Zytoreduktive Chirurgie
  • Selektionskriterien
  • Palliative Therapieoption
  • Morbidität

Keywords

  • Peritoneal carcinomatosis
  • Cytoreductive surgery
  • Selection criteria
  • Palliative therapy option
  • Morbidity