Technik der Peritonektomie sowie der hyperthermen intraperitonealen Chemotherapie

Zusammenfassung

Die Behandlung der Peritonealkarzinose stellt eine große Herausforderung in der Therapie gastro­intestinaler Tumore dar. Ein multimoda­ler The­rapieansatz mit chirurgisch kompletter makroskopischer Zytoreduktion und hyperthermer intraperitonealer Chemotherapie kann bei ausgewählten Patienten zu einer Verbesserung der Prognose führen. Die komplette makrosko­pische Zytoreduktion, bestehend aus parietaler und viszeraler Peritonektomie, oft in Form einer multiviszeralen Resektion, ist operationstechnisch anspruchsvoll und sollte nur von erfah­renen Viszeralchirurgen durchgeführt werden. Zugleich erfordert die hypertherme intraperitoneale Chemotherapie einen großen logistischen Aufwand. Besonders unter Berücksichtigung der langen Lernkurve, die diese Behandlungsform aufweist, sollte die Kombinationstherapie nur in speziellen Zentren angeboten werden. Unter optimalen Voraussetzungen ist die Behandlung mit vertretbarer Morbidität und niedriger Letalität durchführbar. Patienten mit Peritonealkarzinose sollten bezüglich dieser Therapieoption interdisziplinär evaluiert und am besten im Rahmen von Studien behandelt werden.

Abstract

The treatment of peritoneal carcinomatosis represents a challenge in the therapy for gastrointestinal cancer. A multimodal approach with complete surgical cytoreduction and hyperthermic intraperitoneal chemotherapy can improve the prognosis in selected patients. Complete surgical cytoreduction, consisting of partietal and visceral peritonectomy, is a sophisticated procedure, frequently requiring multivisceral resections and should only be performed by experienced visceral surgeons. In addition, hyperthermic intraperitoneal chemotherapy is of some complexity. Furthermore, regarding the learning curve for this procedure, combined treatment should only be performed in specialised centres. Under optimal conditions, the therapy can be carried out with reasonable morbidity and mortality rates. Patients with peritoneal carcinomatosis should be evaluated by an interdisciplinary team concerning this multimodal therapy option and, if applicable, they should be referred to therapy within the framework of clinical studies.

Schlüsselwörter

Peritonealkarzinose - komplett zytoreduktive Chirurgie - HIPEC

Key words

peritoneal carcinosis - complete cytoreductive surgery - HIPEC

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