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Zytoreduktive Chirurgie und hypertherme intraperitoneale Chemoperfusion beim Ovarialkarzinom

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer

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Zusammenfassung

Das Erreichen der makroskopischen Tumorfreiheit im Rahmen der Primäroperation ist der wichtigste Prognosefaktor beim fortgeschrittenen Ovarialkarzinom. Dies geht mit einem medianen Überlebensvorteil von > 5 Jahren einher. Die systematische Lymphonodektomie (LNE) hat beim fortgeschrittenen Ovarialkarzinom mit unauffälligen Lymphknoten nach aktueller Datenlage keinen Einfluss auf das Gesamtüberleben und sollte daher ab dem Stadium IIB, bei in der Bildgebung und palpatorisch unauffälligen Lymphknoten, nicht mehr durchgeführt werden. Standard beim fortgeschrittenen Ovarialkarzinom ist die primäre zytoreduktive Operation. Eine neoadjuvante Therapie sollte aktuell nur durchgeführt werden, wenn eine primäre Tumorreduktion nicht möglich erscheint. Für den Einsatz der hyperthermen intraperitonealen Chemoperfusion (HIPEC) im Rahmen des primären Debulkings konnte bisher kein Überlebensvorteil nachgewiesen werden und deshalb wird HIPEC in diesem Setting nicht empfohlen.

Abstract

The achievement of macroscopically complete tumor resection in primary debulking surgery is the most important prognostic factor in advanced ovarian cancer. This results in a median survival benefit of >5 years. Systematic lymphadenectomy (LNE) is not indicated in advanced ovarian cancer with inconspicuous lymph nodes as it does not prolong overall survival and therefore should no longer be carried out above stage IIB with inconspicuous lymph nodes in imaging and by palpation. Primary cytoreductive surgery is the standard in advanced ovarian cancer. Neoadjuvant therapy is currently an option only if primary cytoreduction does not appear to be possible. For the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in primary debulking surgery a survival benefit has so far not been proven and therefore HIPEC is not recommended in this setting.

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  1. Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    Barbara Schmalfeldt

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Schmalfeldt, B. Zytoreduktive Chirurgie und hypertherme intraperitoneale Chemoperfusion beim Ovarialkarzinom. Chirurgie 93, 1144–1151 (2022). https://doi.org/10.1007/s00104-022-01728-2

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