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Perioperatives Management im Rahmen der CRS und HIPEC

Anästhesiologische Aspekte

Perioperative management for CRS and HIPEC

Anesthesiological aspects

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Zusammenfassung

Die zytoreduktive Chirurgie (CRS) und die hypertherme intraperitoneale Chemotherapie (HIPEC) sind Therapieverfahren zur Behandlung abdomineller Neoplasmen. Hierbei werden zunächst sichtbare Tumorareale im Peritonealraum mittels CRS reseziert. Im Anschluss daran werden verbleibende mikroskopische Tumorareale mittels HIPEC behandelt. Mit diesem Verfahren lässt sich die Lebensqualität verbessern und ein erhöhtes Überleben erzielen. CRS in Kombination mit HIPEC ist ein aufwendiges operatives Verfahren. Die meist jungen und häufig gesunden Patienten unterlaufen im Rahmen der Operation eine Reihe pathophysiologischer Veränderungen. Hier spielen v. a. der massive Volumenverlust und -verschiebung sowie metabolische Veränderungen eine wichtige Rolle für den Anästhesisten. Patienten mit hoher Komorbidität sollten präoperativ optimiert werden, um gerade bei ausgedehnten Eingriffen die perioperative Morbidität und Letalität zu reduzieren.

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are therapeutic options for the treatment of intra-abdominal neoplasms. Following the resection of all visible tumor areas by CRS, microscopic tumor areas are treated with HIPEC. This procedure increases the quality of life and survival. The CRS with HIPEC is a complex surgical procedure in which the mainly younger and often otherwise healthy patients undergo several pathophysiological changes during the operation. The main concern of the anesthesiologist is the massive volume loss, volume shift and metabolic alterations. Patients with a high comorbidity should undergo preoperative optimization to reduce the perioperative morbidity and mortality especially by protracted interventions.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    D. Bleiler, S. Bleiler &  B. Sinner

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  1. D. Bleiler
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Correspondence to B. Sinner.

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D. Bleiler, S. Bleiler und B. Sinner geben an, dass kein Interessenkonflikt besteht.

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

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Bleiler, D., Bleiler, S. & Sinner, B. Perioperatives Management im Rahmen der CRS und HIPEC. Chirurg 89, 687–692 (2018). https://doi.org/10.1007/s00104-018-0677-3

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