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Aktueller Stand der chirurgischen Therapie peritonealer Metastasen bei kolorektalen Karzinomen

Current status of surgical treatment of peritoneal metastases from colorectal cancer

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Zusammenfassung

Die zytoreduktive Chirurgie, vielfach in Kombination mit einer hyperthermen intraperitonealen Chemotherapie (HIPEC), hat maßgeblich zur Verbesserung des Überlebens von Patientinnen und Patienten mit peritonealen Metastasen kolorektaler Karzinome beigetragen. Während für den Nutzen einer vollständigen Zytoreduktion klare Belege existieren, ist der Stellenwert der HIPEC-Behandlung ungeklärt. Eine Oxaliplatin-haltige HIPEC über 30 min war in Studien bei kolorektalen Karzinomen weder in therapeutischer noch in prophylaktischer Indikation klar von Vorteil, verursachte aber relevante Nebenwirkungen und steigerte die Morbidität. Die negativen Ergebnisse dieser Studien in Bezug auf die Oxaliplatin-haltige HIPEC erfordern eine kritische Betrachtung. Sie dürfen aber keinesfalls als allgemeiner Rückschlag für die chirurgische Therapie peritonealer Metastasen missverstanden werden. Während die HIPEC nach einer kompletten chirurgischen Zytoreduktion peritonealer Metastasen kolorektaler Karzinome weiterer Erforschung bedarf, kann die zytoreduktive Chirurgie als hocheffektive Therapie für geeignete Patienten mit einer begrenzten abdominellen Tumoraussaat gelten.

Abstract

Cytoreductive surgery, often in combination with hyperthermic intraperitoneal chemotherapy (HIPEC), has been instrumental in improving the survival of patients with peritoneal metastases from colorectal cancer. Recent studies have highlighted the benefits of complete cytoreduction, while the role of the HIPEC treatment remains unclear. An oxaliplatin-based HIPEC over 30 min could not achieve any clear benefits in studies on colorectal cancer, neither in the therapeutic nor in the prophylactic setting, but caused relevant side effects and increased the morbidity. The negative results of these studies with respect to oxaliplatin-based HIPEC require critical appraisal; however, they should by no means be regarded as a general setback for surgical treatment of peritoneal metastases and be misunderstood as a general failure of this treatment. While HIPEC after complete surgical cytoreduction of peritoneal metastases from colorectal cancer requires further research, cytoreductive surgery should still be regarded as a highly effective treatment for suitable patients with limited abdominal tumor dissemination.

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Authors and Affiliations

  1. Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland

    Can Yurttas, Markus W. Löffler, Alfred Königsrainer & Philipp Horvath

  2. Partnerstandort Tübingen, Deutsches Konsortium für Translationale Krebsforschung (DKTK) am Deutschen Krebsforschungszentrum (DKFZ), Tübingen, Deutschland

    Markus W. Löffler & Alfred Königsrainer

  3. Exzellenzcluster iFIT (EXC2180) „Individualisierung von Tumortherapien durch molekulare Bildgebung und funktionelle Identifizierung therapeutischer Zielstrukturen“, Universität Tübingen, Tübingen, Deutschland

    Markus W. Löffler & Alfred Königsrainer

  4. Interfakultäres Institut für Zellbiologie, Abteilung für Immunologie, Universität Tübingen, Tübingen, Deutschland

    Markus W. Löffler

  5. Abteilung für klinische Pharmakologie, Universitätsklinikum Tübingen, Tübingen, Deutschland

    Markus W. Löffler

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  1. Can Yurttas
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Correspondence to Can Yurttas.

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Interessenkonflikt

C. Yurttas, M.W. Löffler, A. Königsrainer und P. Horvath geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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C. Bruns, Köln

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Yurttas, C., Löffler, M.W., Königsrainer, A. et al. Aktueller Stand der chirurgischen Therapie peritonealer Metastasen bei kolorektalen Karzinomen. Chirurgie 93, 1126–1132 (2022). https://doi.org/10.1007/s00104-022-01694-9

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  • DOI: https://doi.org/10.1007/s00104-022-01694-9

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