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Einfluss und Toxizität perioperativer Therapien auf die onkologische Chirurgie

Influence and toxicity of perioperative therapy on surgical management of cancer

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Bei zahlreichen gastrointestinalen Tumoren, wie dem Ösophaguskarzinom, dem Magenkarzinom, dem Rektumkarzinom, sowie bei der Behandlung kolorektaler Lebermetastasen führt eine perioperative multimodale Therapie zu einer Prognoseverbesserung.

Ziel

Durch präoperative Therapien soll u. a. die Chance auf eine R0-Resektion des Tumors steigen, somit ist das Ausmaß einer histopathologischen Tumorregression von prognostischer Bedeutung. Die chirurgische Resektion ist hierbei nach wie vor zentraler Bestandteil einer kurativ intendierten Therapie.

Material und Methoden

Diese Arbeit basiert auf einer selektiven Literaturrecherche der Datenbanken PubMed, National Comprehensive Cancer Network (NCCN) und den aktuellen S3-Leitlinien zum Thema „Perioperative/neoadjuvante Chemo‑, Immun- und Radiotherapie“.

Ergebnisse

Moderne onkologische Therapiekonzepte umfassen besonders die perioperative Chemotherapie und/oder die Radiochemotherapie und erhöhen nach aktuellen Studiendaten maßgeblich die Rate der Resektabilität (generell und speziell R0), ohne die postoperative Morbidität oder Mortalität wesentlich zu erhöhen.

Schlussfolgerung

Die Auswahl und Kombination der entsprechenden multimodalen Therapieansätze erfordert eine umfassende interdisziplinäre Abstimmung hinsichtlich der zeitlichen Abfolge der Therapiemodalitäten. Daneben ist ein umfassendes Management von Nebenwirkungen essenziell. Therapiestandards unterliegen einem stetigen Wandel; der vorliegende Überblick über multimodale Therapiekonzepte und ihre Bedeutung für das chirurgische Vorgehen soll dazu beitragen, bei Therapieentscheidungen zu unterstützen.

Abstract

Background

Perioperative multimodal therapy improves clinical outcome in many different malignant tumors, such as esophageal cancer, gastric cancer, rectal cancer as well as liver metastases of colorectal cancer.

Aim

The goal of multimodal treatments is to increase the R0 resection rates, since histopathological regression has prognostic implications. Surgical resection still plays a crucial role in curatively intended treatment.

Materials and methods

This work is based on a selective literature review of the databases PubMed and the National Comprehensive Cancer Network (NCCN) as well as the respective S3-guidelines on the subject of “Perioperative/neoadjuvant chemo-, immuno-, or radiotherapy”.

Results

Modern oncological therapy concepts mainly include perioperative chemotherapy and/or radiochemotherapy and drastically improve the rate of resectability without substantially increasing postoperative morbidity or mortality.

Discussion

Selecting a multimodal treatment strategy requires extensive interdisciplinary coordination with regard to the chronological sequence of the therapeutic modalities. In addition, comprehensive management of side effects is essential. Therapeutic standards are continuously changing; thus, this review of current multimodal treatment concepts and their implications for surgical management is intended to help guide treatment decisions.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Visceral‑, Thorax- und Gefäßchirurgie, Fakultät für Gesundheitswissenschaften (FGW) Brandenburg, Medizinische Hochschule Brandenburg (MHB) Theodor Fontane, Campus Neuruppin, Fehrbelliner Straße 38, 16816, Neuruppin, Deutschland

    Stephan Gretschel

  2. Abteilung für Strahlentherapie und Radioonkologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Patrick Naumann

  3. Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Georg Martin Haag

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  1. Stephan Gretschel
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Correspondence to Stephan Gretschel.

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Interessenkonflikt

G.M. Haag weist auf folgende Beziehungen hin: Beratertätigkeit: Bristol-Myers Squibb, MSD Sharp & Dohme, EsoCap, Lilly; Honoraria: Servier, MSD Sharp & Dohme, Lilly; Forschungsförderung: Nordic Pharma; Taiho Pharmaceutical, MSD Sharp & Dohme. Reisekostenerstattung: Bristol-Myers Squibb; Lilly. S. Gretschel und P. Naumann 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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Gretschel, S., Naumann, P. & Haag, G.M. Einfluss und Toxizität perioperativer Therapien auf die onkologische Chirurgie. Onkologe 27, 308–320 (2021). https://doi.org/10.1007/s00761-020-00897-1

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