Skip to main content
SpringerLink
Log in

Gefäßersatz in der abdominellen Tumorchirurgie

Vascular replacement in abdominal tumor surgery

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Im Rahmen onkologisch-viszeralchirurgischer Operationen wird der Chirurg immer wieder mit anatomischen Barrieren konfrontiert. Insbesondere abdominale Sarkome, aber auch Karzinome erfordern bisweilen ein gefäßchirurgisches Handeln, um eine radikale und damit kurative Therapie erzielen zu können. Durch den Einsatz gefäßchirurgischer Techniken besteht die Möglichkeit bei onkologischen Patienten die Grenzen der Operabilität sinnvoll zu erweitern und ein langes tumorfreies Überleben zu ermöglichen. Für jedes betroffene arterielle und venöse Stromgebiet ergeben sich besondere Rekonstruktionsmethoden, die eines optimalen Gefäßersatzes bedürfen. Das Ziel der Gefäßresektion und -rekonstruktion soll unter Berücksichtigung der Radikalität auf die Wiederherstellung der durch die Tumorresektion ausgefallenen Zirkulation gerichtet sein.

Abstract

As part of oncologic visceral surgical operations the surgeon is confronted with anatomical barriers. In particular abdominal sarcomas and carcinomas sometimes require a vascular surgical procedure in order to achieve a radical and curative treatment. By using vascular surgical techniques there is the possibility for oncology patients to expand the boundaries of operability and to allow a long tumor-free survival. For each affected arterial and venous structure there are special reconstruction methods which require an optimal vascular graft. The aim of vascular resection and reconstruction should focus not only on the radicality of the operation but should also take the optimal circulation recovery of blood in the tumor resected area into account.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11

Literatur

  1. Al-Saif OH, Sengupta B, Amr S, Meshikhes AW (2011) Leiomyosarcoma of the infra-renal inferior vena cava. Am J Surg 201(2):e18–20

    Article  PubMed  Google Scholar 

  2. Amano H, Miura F, Toyota N et al (2009) Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer. J Hepatobiliary Pancreat Surg 16(6):777–780

    Article  PubMed  Google Scholar 

  3. Amano H, Miura F, Toyota N et al (2009) Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer? J Hepatobiliary Pancreat Surg 16(6):850–857

    Article  PubMed  Google Scholar 

  4. Belch JJF et al (2010) CASPAR Trial. J Vasc Surg 52:825–833

    Article  PubMed  Google Scholar 

  5. Chakravarty KD, Hsu JT, Liu KH et al (2010) Prognosis and feasibility of en-bloc vascular resection in stage II pancreatic adenocarcinoma. World J Gastroenterol 16(8):997–1002

    Article  PubMed  CAS  Google Scholar 

  6. Chua TC, Saxena A (2010) Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg 14(9):1442–1452

    Article  PubMed  Google Scholar 

  7. Chun YS, Milestone BN, Watson JC et al (2010) Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol 17(11):2832–2838

    Article  PubMed  Google Scholar 

  8. Fiore M, Colombo C, Locati P et al (2011) Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol (in press)

  9. Fortner JG, Shiu MH, Kinne DW et al (1974) Major hepatic resection using vascular isolation and hypothermic perfusion. Ann Surg 180(4):644–652

    Article  PubMed  CAS  Google Scholar 

  10. Glanemann M, Shi B, Liang F et al (2008) Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery? World J Surg Oncol 6:123

    Article  PubMed  Google Scholar 

  11. Grotemeyer D, Pillny M, Luther B et al (2003) Reconstruction of the inferior vena cava for extended resection of malignant tumors. Chirurg 74(6):547–553

    Article  PubMed  CAS  Google Scholar 

  12. Hackert T, Büchler MW, Werner J (2009) Surgical options in the management of pancreatic cancer. Minerva Chir 64(5):465–476

    PubMed  CAS  Google Scholar 

  13. Hackert T, Werner J, Weitz J et al (2010) Uncinate process first – a novel approach for pancreatic head resection. Langenbecks Arch Surg 395(8):1161–1164

    Article  PubMed  Google Scholar 

  14. Hartel M, Niedergethmann M, Farag-Soliman M et al (2002) Benefit of venous resection for ductal adenocarcinoma of the pancreatic head. Eur J Surg 168(12):707–712

    Article  PubMed  Google Scholar 

  15. Hohenberger P, Allenberg JR, Schlag PM, Reichardt P (1999) Results of surgery and multimodal therapy for patients with soft tissue sarcoma invading to vascular structures. Cancer 85(2):396–408

    Article  PubMed  CAS  Google Scholar 

  16. Hohenberger P, Schwarzbach M (2007) Rekonstruktive Gefäßchirurgie im Rahmen erweiterter Tumorchirurgie. In: Hepp W, Kogel H (Hrsg) Gefäßchirurgie. Urban & Fischer, München, S 597–607

  17. Hollenbeck ST, Grobmyer SR, Kent KC, Brennan MF (2003) Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg 197(4):575–579

    Article  PubMed  Google Scholar 

  18. Homayounfar K, Liersch T, Niessner M et al (2010) Multimodal treatment options for bilobar colorectal liver metastases. Langenbecks Arch Surg 395(6):633–641

    Article  PubMed  Google Scholar 

  19. Kahlert C, M W B, Weitz J (2008) Extended lymphadenectomy and vascular resection for pancreatic cancer. Chirurg 79(12):1115–1122

    Article  PubMed  CAS  Google Scholar 

  20. Katz MH, Pisters PW, Evans DB et al (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206(5):833–848

    Article  PubMed  Google Scholar 

  21. Katz MH, Pisters PW, Lee JE, Fleming JB (2011) Borderline resectable pancreatic cancer: what have we learned and where do we go from here? Ann Surg Oncol 18(3):608–610

    Article  PubMed  Google Scholar 

  22. Lehnert T, Cardona S, Hinz U et al (2009) Primary and locally recurrent retroperitoneal soft-tissue sarcoma: local control and survival. Eur J Surg Oncol 35(9):986–993

    Article  PubMed  CAS  Google Scholar 

  23. Leowardi C, Hinz U, Hormann Y et al (2005) Malignant vascular tumors: clinical presentation, surgical therapy, and long-term prognosis. Ann Surg Oncol 12(12):1090–1101

    Article  PubMed  Google Scholar 

  24. Limmer S, Oevermann E, Killaitis C et al (2010) Sequential surgical resection of hepatic and pulmonary metastases from colorectal cancer. Langenbecks Arch Surg 395(8):1129–1138

    Article  PubMed  Google Scholar 

  25. Luther B, Kniemeyer H, Behrendt P, Sandmann W (1996) Vascular surgery operations in tumor diseases. Langenbecks Arch Chir Suppl Kongressbd 113:186–188

    PubMed  CAS  Google Scholar 

  26. McKay A, Motamedi M, Temple W et al (2007) Vascular reconstruction with the superficial femoral vein following major oncologic resection. J Surg Oncol 96(2):151–159

    Article  PubMed  Google Scholar 

  27. Mehrabi A, Mood ZA, Roshanaei N et al (2008) Mesohepatectomy as an option for the treatment of central liver tumors. J Am Coll Surg 207(4):499–509

    Article  PubMed  Google Scholar 

  28. Mehrabi A, Fonouni H, Golriz M et al (2011) Hypothermic ante situm resection in tumors of the hepatocaval confluence. Dig Surg 28(2):100–108

    Article  PubMed  Google Scholar 

  29. Müller SA, Hartel M, Mehrabi A et al (2009) Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 13(4):784–792

    Article  PubMed  Google Scholar 

  30. Munene G, Mack LA, Moore RD, Temple WJ (2011) Neoadjuvant radiotherapy and reconstruction using autologous vein graft for the treatment of inferior vena cava leiomyosarcoma. J Surg Oncol 103(2):175–178

    Article  PubMed  Google Scholar 

  31. Ouriel K et al (1998) TOPAS-Trial. N Engl J Med 338(16):1105–1111

    Article  PubMed  CAS  Google Scholar 

  32. Reissfelder C, Koch M, Büchler MW, Weitz J (2007) Pancreatic carcinoma. Chirurg 78(11):1059–1071

    Article  PubMed  CAS  Google Scholar 

  33. Sandmann W, Kremer K (1983) Material problems in vascular surgery. Chirurg 54(7):433–443

    PubMed  CAS  Google Scholar 

  34. Sandmann W, Luther B (2006) Gefäßchirurgie im Rahmen der onkologischen Chirurgie. In: Siewert JR, Rothmund M, Schumpelick V (Hrsg) Praxis der Viszeralchirurgie. Springer. Berlin Heidelberg New York, S 854–871

  35. Sargent M, Boeck S, Heinemann V et al (2011) Surgical treatment concepts for patients with pancreatic cancer in Germany – results from a national survey conducted among members of the „Chirurgische Arbeitsgemeinschaft Onkologie“ (CAO) and the „Arbeitsgemeinschaft Internistische Onkologie“ (AIO) of the Germany Cancer Society (DKG). Langenbecks Arch Surg 396(2):223–229

    Article  PubMed  Google Scholar 

  36. Schimmack S, Büchler MW, Weitz J (2009) Surgical therapy of abdominal and trunk soft tissue sarcomas. Chirurg 80(3):202–208

    Article  PubMed  CAS  Google Scholar 

  37. Schwarzbach MH, Hormann Y, Hinz U et al (2005) Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity. J Vasc Surg 42(1):88–97

    Article  PubMed  Google Scholar 

  38. Schwarzbach MH, Hinz U, Dimitrakopoulou-Strauss A et al (2005) Prognostic significance of preoperative [18-F] fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in patients with resectable soft tissue sarcomas. Ann Surg 241(2):286–294

    Article  PubMed  Google Scholar 

  39. Schwarzbach MH, Hormann Y, Hinz U et al (2006) Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg 44(1):46–55

    Article  PubMed  Google Scholar 

  40. Settmacher U, Langrehr JM, Husmann I et al (2004) Reconstruction of visceral arteries with homografts in excision of the pancreas. Chirurg 75(12):1199–1206

    Article  PubMed  CAS  Google Scholar 

  41. Settmacher U, Thelen A, Jonas S et al (2005) Resection and reconstruction of the retrohepatic vena cava in combination with liver resections. Zentralbl Chir 130(2):104–108

    Article  PubMed  CAS  Google Scholar 

  42. Siriwardana HP, Siriwardena AK (2006) Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg 93(6):662–673

    Article  PubMed  CAS  Google Scholar 

  43. Song TK, Harris EJ Jr, Raghavan S, Norton JA (2009) Major blood vessel reconstruction during sarcoma surgery. Arch Surg 144(9):817–822

    Article  PubMed  Google Scholar 

  44. Stauffer JA, Dougherty MK, Kim GP, Nguyen JH (2009) Interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy. Br J Surg 96(3):247–252

    Article  PubMed  CAS  Google Scholar 

  45. Tangelder MJD et al (2001) BOA-Study. J Vasc Surg 33:523–527

    Article  Google Scholar 

  46. Trede M, Rumstadt B, Storz LW (1998) Vascular surgery within the scope of visceral surgery-oncologic interventions. Chirurg 69(1):8–18

    Article  PubMed  CAS  Google Scholar 

  47. Weitz J, Koch M, Friess H, Büchler MW (2004) Impact of volume and specialization for cancer surgery. Dig Surg 21(4):253–261

    Article  PubMed  Google Scholar 

  48. Weitz J, Kienle P, Schmidt J et al (2007) Portal vein resection for advanced pancreatic head cancer. J Am Coll Surg 204(4):712–716

    Article  PubMed  Google Scholar 

  49. Weitz J, Rahbari N, Koch M, Büchler MW (2010) The „artery first“ approach for resection of pancreatic head cancer. J Am Coll Surg 210(2):e1–4

    Article  PubMed  Google Scholar 

  50. Wente MN, Schwarzbach MH, Hinz U et al (2007) Perioperative outcome in sarcoma surgery. Langenbecks Arch Surg 392(1):83–93

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Chirurgische Universitätsklinik Heidelberg, INF 110, 69120, Heidelberg, Deutschland

    A. Mehrabi, P. Houben, M.W. Büchler & J. Weitz

  2. Klinik für Gefäßchirurgie, Chirurgische Universitätsklinik Heidelberg, Heidelberg, Deutschland

    N. Attigah & D. Böckler

Authors
  1. A. Mehrabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Houben
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Attigah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Böckler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M.W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Weitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Mehrabi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mehrabi, A., Houben, P., Attigah, N. et al. Gefäßersatz in der abdominellen Tumorchirurgie. Chirurg 82, 887–897 (2011). https://doi.org/10.1007/s00104-011-2096-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-011-2096-6

Schlüsselwörter

Keywords

Search

Navigation