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Onkologische Chirurgie im interdisziplinären Kontext – auf dem Weg zur personalisierten Medizin

Oncological surgery in the interdisciplinary context—On the way to personalized medicine

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Zusammenfassung

Die onkologische Chirurgie ist eine eng mit anderen klinischen Partnern interagierende Disziplin und bleibt vielfach die Grundlage einer kurativen Therapie solider Malignome. Durch die Fortschritte im Bereich der Systemtherapien einerseits sowie durch operationstechnische Innovationen andererseits verändert sich auch die Indikationsstellung in der onkologischen Chirurgie, wie z. B. Indikationserweiterungen für Patienten mit einer Oligometastasierung. Die Chirurgie von Metastasen ist für das kolorektale Karzinom seit Langem etabliert und wird auch bei anderen Entitäten, wie dem Pankreas- und Magenkarzinom, innerhalb kontrollierter randomisierter klinischer Studien weiter geprüft (z. B. RENAISSANCE und METAPANC). Eine neue Herausforderung stellt der Umgang mit dem Vorliegen einer klinischen Komplettremission nach totaler neoadjuvanter Therapie beispielsweise beim lokal fortgeschrittenen Rektumkarzinom, aber auch beim Ösophaguskarzinom dar. Hier wird zunehmend ein Organ- und Funktionserhalt gefordert. Dieses Vorgehen sollte vorerst allerdings nur in Studien erfolgen, bis eine Stratifizierung es erlaubt, Patienten zu identifizieren, bei denen dieses Konzept onkologisch sicher durchführbar ist. Der personalisierte Einsatz onkologischer Chirurgie ist patientenabhängig, tumorabhängig sowie abhängig vom gesamten multimodalen Konzept.

Abstract

Oncological surgery is a discipline which closely interacts with other clinical partners and remains in many cases the cornerstone of a curative treatment of solid tumors. Due to the progress in the field of systemic tumor treatment as well as innovations in surgical techniques, the indications in oncological surgery are also changing, such as extended indications for patients with oligometastatic disease. Surgery of metastases has long been established for colorectal cancer and is being further tested for other entities, such as pancreatic and gastric cancer, within randomized controlled clinical trials (e.g. RENAISSANCE and METAPANC). A new challenge is the handling of a clinical complete remission after total neoadjuvant therapy, for example in locally advanced rectal cancer or in esophageal cancer. Here, organ and function preservation are increasingly propagated but should only be performed within clinical trials until stratification enables the identification of patients in whom this concept is oncologically safe. The personalized use of oncological surgery is dependent on the patient, the tumor and on the total multimodal concept.

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  1. Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    Lena-Christin Conradi &  Michael Ghadimi

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Conradi, LC., Ghadimi, M. Onkologische Chirurgie im interdisziplinären Kontext – auf dem Weg zur personalisierten Medizin. Chirurg 93, 234–241 (2022). https://doi.org/10.1007/s00104-022-01614-x

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