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Onkologische Notfälle in der Viszeralchirurgie

Oncologic emergencies in visceral surgery

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Onkologisch-viszeralchirurgische Notfälle stellen bezüglich der Realisierung einer onkologisch und funktionell adäquaten operativen Versorgung ein besonderes Problem dar. Aufgrund ihrer relativ geringen Häufigkeit sowie v. a. wegen der Individualität jedes einzelnen Falles ist der Grad der Evidenz bezüglich Diagnostik und Therapie nicht sehr hoch. Er liegt überwiegend auf dem Niveau der Expertenmeinung. Bei einem Teil der Patienten wird die onkologische Grunderkrankung erst durch die notfallmäßig vorzunehmende Operation bekannt. Für viele solide Tumoren ist die chirurgische Therapie unter Einhaltung onkologischer Radikalitätsprinzipien die Basis eines kurativen Behandlungsansatzes. Die Therapie muss deshalb sicherstellen, dass keine notfallbedingte zusätzliche Verschlechterung der Prognose eintritt.

Das Spektrum beschränkt sich trotz der vielfältigen Ursachen und Manifestationen auf 3 klinische Erscheinungsbilder: den Ileus, die Peritonitis und die akute Blutung. Eine Reihe von grundsätzlichen klinischen Zustandsbildern, diagnostischen Maßnahmen und therapeutischen Optionen, die es durch ihre unterschiedliche Kombination erlauben, der erforderlichen Individualisierung von Diagnostik und Therapie Rechnung zu tragen, werden geordnet nach den Organzugehörigkeiten und der Notfallursache dargestellt.

Abstract

Due to the difficulty of achieving oncologically as well as functionally acceptable results, management of oncologic emergencies represents a special problem in visceral surgery. The level of evidence in diagnostic and therapeutic procedures is not well documented because each case concerns an individual connected with a relatively low incidence. In most patients the oncological diagnosis is first determined at the time of an emergent operation. In cases of solid tumors, radical tumor resection adhering to oncologic criteria is an important factor for possible curative treatment. Therapy should ensure that no additional deterioration of the patient’s prognosis is caused. In spite of many possible causes and different clinical manifestations of oncologic emergencies, the spectrum of clinical appearances focuses on three symptoms—ileus, peritonitis, and acute bleeding. A series of fundamental clinical conditions, diagnostic procedures, and therapeutic options that facilitate individualized diagnostics and therapy are presented in this paper taking into consideration the specific organs and causes of the emergency.

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Authors and Affiliations

  1. Abt. für Visceral- und Transplantationschirurgie, Universitätsklinikum Ulm

    P. Würl & D. Henne-Bruns

  2. Abt. für Visceral- und Transplantationschirurgie, Universitätsklinikum Ulm, Steinhövelstraße 9, 89075, Ulm

    P. Würl

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  1. P. Würl
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  2. D. Henne-Bruns
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Correspondence to P. Würl.

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Würl, P., Henne-Bruns, D. Onkologische Notfälle in der Viszeralchirurgie. Onkologe 10, 386–401 (2004). https://doi.org/10.1007/s00761-004-0700-9

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  • DOI: https://doi.org/10.1007/s00761-004-0700-9

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