Rekonstruktion onkologischer Defekte im Becken-Perinealbereich – Bericht zum Konsensus-Workshop im Rahmen der 44. Jahrestagung der DAM 2023 in Bern, CH

Zusammenfassung

Die chirurgisch-onkologische Therapie von Malignomen im Becken- und Perinealbereich geht mit einer hohen Komplikationsrate und Morbidität für Patientinnen und Patienten einher. Moderne multimodale Therapiekonzepte, wie etwa beim Anal- oder Rektumkarzinom mit neoadjuvanter Radio-Chemotherapie, erhöhen die Langzeit-Überlebensrate und senken das lokale Rezidivrisiko. Gleichzeitig geht die zunehmende chirurgische Radikalität und die höhere onkologische Sicherheit bei weiten Resektionsgrenzen zwangsläufig mit größeren und durch die Bestrahlung komplexeren Gewebedefekten am Beckenboden, perineal und sakral einher. Die plastisch-chirurgische Rekonstruktion von komplexen Defekten im Becken-Perinealbereich nach onkologischer Resektion bleibt daher nach wie vor herausfordernd. Das rekonstruktive Rüstzeug und somit die Behandlung solcher Defekte ist breit und reicht von lokalen und regionalen Lappenplastiken, über muskelbasierte bis hin zu mikrovaskulären und perforatorbasierten Verfahren. Während die Verwendung von Lappenplastiken mit einer mittlerweile in der Literatur gut dokumentierten, signifikanten Reduktion der postoperativen Komplikationen im Vergleich zum primären Verschluss einhergeht, fehlt es weiterhin an belastbaren Daten, welche die postoperativen Ergebnisse verschiedener rekonstruktiver Ansätze direkt miteinander vergleichen. Zudem zeigt die aktuellen Datenlage, dass die Erfassung der Lebensqualität dieser Patienten nur selten standardisiert erfolgt. Im Konsensus-Workshop der 44. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie zum Thema «Rekonstruktion onkologischer-Defekte im Becken-Perinealbereich» wurde die aktuelle Literatur diskutiert und Empfehlungen zur Rekonstruktion komplexer Defekte in diesem Bereich erarbeitet. Das Ziel dieses Workshops bestand darin, Wissenslücken zu identifizieren und soweit möglich einen Expertenkonsens zu etablieren, um die Qualität in der Rekonstruktion auf diesem anspruchsvollen Gebiet zu gewährleisten und kontinuierlich zu verbessern. Zudem wurde der Stellenwert vom «patient-reported outcome measure» in der Beckenrekonstruktion hervorgehoben und der Wille für dessen flächendeckenden Einsatz in einer patienten-zentrierten Gesundheitsversorgung festgehalten.

Abstract

The surgical-oncological treatment of pelvic and perineal malignancies is associated with a high complication rate and morbidity for patients. Modern multimodal treatment modalities, such as neoadjuvant radio-chemotherapy for anal or rectal cancer, increase the long-term survival rate while reducing the risk of local recurrence. Simultaneously, the increasing surgical radicality and higher oncological safety with wide resection margins is inevitably associated with larger and, due to radiation, more complex tissue defects in the perineal and sacral parts of the pelvic floor. Therefore, the plastic-surgical reconstruction of complex pelvic-perineal defects following oncological resection remains challenging. The reconstructive armamentarium, and thus the treatment of such defects, is broad and ranges from local, regional and muscle-based flaps to microvascular and perforator-based procedures. While the use of flaps is associated with a significant, well-documented reduction in postoperative complications compared to primary closure, there is still a lack of reliable data directly comparing the postoperative results of different reconstructive approaches. Additionaly, the current data shows that the quality of life of these patients is rarely recorded in a standardised manner. In a consensus workshop at the 44^th annual meeting of the German-speaking Association for Microsurgery on the topic of „Reconstruction of oncological defects in the pelvic-perineal area“, the current literature was discussed and recommendations for the reconstruction of complex defects in this area were developed. The aim of this workshop was to identify knowledge gaps and establish an expert consensus to ensure and continuously improve the quality of reconstruction in this challenging area. In addition, the importance of the „patient-reported outcome measures“ in pelvic reconstruction was highlighted, and the commitment to its widespread use in the era of value-based healthcare was affirmed.

Schlüsselwörter

Perineale Rekonstruktion - Lebensqualität - Perforator Lappenplastik - Muskulokutane Lappenplastik

Keywords

perineal reconstruction - patient-reported outcome measures - perforator flap - quality of life - musculocutaneous flap

Publication History

Received: 01 April 2024

Accepted: 26 June 2024

Article published online:
13 August 2024

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