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Peritonealkarzinose

Peritoneal carcinomatosis

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Zusammenfassung

Die Peritonektomie (PE) kombiniert mit hyperthermer intraperitonealer Chemotherapie (HIPEC) etabliert sich zunehmend als potenziell kurative Therapieoption bei Patienten mit peritoneal metastasierten gastrointestinalen und gynäkologischen Tumoren sowie primär peritonealen Malignomen. Entscheidend für die Prognose ist die möglichst komplette Zytoreduktion, die bei den allermeisten Fällen neben der partiellen bis subtotalen parietalen PE auch eine Multiorganresektionen erforderlich macht. Im Vordergrund steht dabei, für den Patienten eine adäquate Lebensqualität bei maximaler Tumorresektion zu erhalten. Die Morbidität nach PE und HIPEC liegt in erfahrenen Zentren zwischen 25 und 35% bei einem Mortalitätsrisiko von <5%. Zu beachten sind nicht nur chirurgisch technische Aspekte und die intraoperative Entscheidungsfindung, sondern auch das intraoperative anästhesiologische Management, die Intensivtherapie, die Schmerztherapie, das Komplikationsmanagement, die Physiotherapie und anderes mehr. Die wohl größte Herausforderung im Management der Peritonealkarzinose bleibt die Patientenselektion. Der Schnittbildgebung in Verbindung mit der FDG-PET fällt hierbei eine wichtige Rolle zur Abschätzung der Operabilität zu.

Abstract

Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is now an established therapy with a curative option for patients with gastrointestinal and gynecological peritoneal carcinomatosis as well as for primary peritoneal carcinomatous tumors. Decisive for the prognosis is a complete cytoreduction, which in most cases necessitates multi-organ resection in addition to a partial or subtotal parietal peritonectomy (PE). The highest priority is given to maintain an adequate quality of life for the patient while performing maximum tumor resection. The morbidity following PE and HIPEC in experienced centers lies between 25% and 35% with a mortality risk of <5%. Consideration must be given not only to the technical surgical aspects and the intraoperative decision-making but also to the intraoperative management, intensive care therapy, pain therapy, management of complications, physiotherapy and many more. The greatest challenge in the management of peritoneal carcinomatosis is still patient selection. Computed tomography imaging together with 18fluorodeoxyglucose positron emission tomography (FDG-PET) plays an important role in the assessment of operability.

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

    I. Königsrainer, S. Beckert, T. Lehmann, R. Ladurner, B. Brücher &  A. Königsrainer

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  1. I. Königsrainer
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  2. S. Beckert
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  3. T. Lehmann
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  4. R. Ladurner
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  5. B. Brücher
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  6. A. Königsrainer
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Correspondence to A. Königsrainer.

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Königsrainer, I., Beckert, S., Lehmann, T. et al. Peritonealkarzinose. Chirurg 82, 375–381 (2011). https://doi.org/10.1007/s00104-010-2049-5

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  • DOI: https://doi.org/10.1007/s00104-010-2049-5

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