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Onkologische Notfälle in der Abdominalchirurgie

Oncologic emergencies in abdominal surgery

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Onkologische Notfälle in der Viszeralchirurgie stellen keine Seltenheit, jedoch eine erhebliche Herausforderung für den behandelnden Chirurgen und den Patienten gleichermaßen dar. Der Patient ist durch die Tumorerkrankung latent und durch die Notfallsituation akut gefährdet. Der Chirurg muss daher nicht nur dem Notfall an sich, sondern auch der gesamtonkologische Situation bei seiner Entscheidungsfindung für eine Therapie und während dieser Phase Rechnung tragen. Hierbei sollten auch stets die individuellen Patientenwünsche und -vorstellungen beachtet und, wenn möglich, die Angehörigen in den Entscheidungsprozess eingebunden werden. Ein wesentlicher Punkt im Zuge der Bewertung des Notfalls ist neben der Indikationsstellung für eine Operation die Unterscheidung zwischen einer palliativen und kurativen onkologischen Gesamtkonstellation. Dies erfordert daher neben der chirurgischen Erfahrung für die Notfalloperation auch eine entsprechende onkologische Expertise des Chirurgen.

Ziel

Ziel war die Erstellung eines Überblicks und Zusammenfassung der aktuellen chirurgischen und interventionellen Behandlungsmöglichkeiten onkologischer Notfälle in der Abdominalchirurgie.

Material und Methoden

Es wurde eine selektive PubMed-basierte Literaturrecherche zum Thema chirurgischer und interventioneller Therapiemöglichkeiten onkologischer Notfälle in der Abdominalchirurgie, insbesondere im Hinblick auf Tumorblutung, -perforation und -obstruktion im Bereich des Gastrointestinaltrakts durchgeführt und deren Ergebnisse zusammengefasst und aufbereitet.

Ergebnis

Der Artikel bietet einen Überblick über den aktuellen Stand der Behandlungsmöglichkeiten onkologischer Notfälle im Bereich der Abdominalchirurgie.

Abstract

Background

Oncologic emergencies in abdominal surgery are often life-threatening situations for patients with (potentially incurable) malignant diseases, challenging both the surgeon and the patient. The tumor disease represents a latent and the emergency situation an acute danger for the patient. Treatment must take into account the whole oncologic situation, which can often only be overviewed during surgery itself. Furthermore, the wishes and views of the individual patients must be respected and, where possible, relatives involved in the decision-making process. In addition to establishing the surgical indication, another important aspect during evaluation of the emergency is the distinction between a palliative and a curative overall constellation. Thus, a high level of experience in emergency as well as oncologic surgery is mandatory.

Objective

The aim of this article was to summarize and overview current surgical and interventional options for treatment of oncologic patients with abdominal emergencies.

Material and methods

We performed and analyzed a selective search of the PubMed literature and reviewed the surgical and alternative, non-operative, interventional therapy alternatives in acute situations such as tumor hemorrhage, perforation, and bowel/biliary tract obstruction.

Results

This article provides an overview of the currently available treatment options for acute oncological emergencies in general and abdominal surgery.

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Danksagung

Wir danken C. Schubert und M. Amler für die Bereitstellung der Röntgenbilder zur Abb. 1a, b.

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Authors and Affiliations

  1. Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland

    A. Bogner &  S. Pistorius

  2. Abteilung für Allgemein- und Viszeralchirurgie, Asklepios-ASB Klinik Radeberg, Pulsnitzer Str. 60, Radeberg, Deutschland

    S. Pistorius

Authors
  1. A. Bogner
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  2. S. Pistorius
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Correspondence to S. Pistorius.

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Interessenkonflikt

A. Bogner und S. Pistorius geben an, dass kein Interessenkonflikt besteht.

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

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Bogner, A., Pistorius, S. Onkologische Notfälle in der Abdominalchirurgie. Onkologe 26, 97–104 (2020). https://doi.org/10.1007/s00761-019-00682-9

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  • DOI: https://doi.org/10.1007/s00761-019-00682-9

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