Inoperable Genitaltumoren der Frau: Therapeutische Optionen bei Darmstenose und -blutung

Zusammenfassung

Hintergrund: Tumoren der weiblichen Genitale werden nicht selten erst im fortgeschrittenen Stadium diagnostiziert oder rezidivieren nach zunächst kurativer Therapie. Insbesondere Ovarialkarzinome gehen im Verlauf häufig mit einer Peritonealkarzinose oder lokalem Tumorprogress einher, was zu einer Reihe behandlungsbedürftiger intestinaler Komplikationen führen kann. Material und Methoden: Basierend auf eigenen Ergebnissen und einer systematischen PubMed-Recherche erfolgte die Definition unterschied­licher intestinaler Komplikationen nicht kurabler Genitaltumoren der Frau sowie die Analyse unterschiedlicher chirurgischer und konservativer Therapieoptionen. Ergebnisse: Häufig treten Dünndarmstenosen aufgrund einer direkten Tumorinfiltration, Peritonealkarzinose oder postoperativen Verwachsungen auf, die zu einem akuten und häufig auch chronisch rezidivierenden Ileusbild führen können. Im kleinen Becken sind insbesondere das Rektum und das Sigma von extraluminalen Tumorstenosen, von Fisteln oder von einer direkten Tumorinfiltration betroffen, die unter Umstän­den mit ernsthaften Blutungen oder einem Dick­darmileus vergesellschaftet sind. Eine zusätzliche Form der intestinalen Komplikationen stellen postradiogene Verwachsungen und Stenosen im Bereich des Dünndarms sowie die chronische Strahlenproktitis nach vorangegangener Radiatio dar. In der palliativen Behandlungssituation ist ein spezielles Augenmerk auf eine abwägende Indi­kationsstellung zur chirurgischen, onkologischen und konservativen Therapie zu richten. Schlussfolgerung: Das Diktum des „primum nihil nocere“ ist unter Berücksichtigung des Patientenwillens, der anzunehmenden Prognose, des All­gemeinzustands und des Leidensdrucks sowie der zu erwartenden Komplikationen in besonderem Maße zu beachten. 

Abstract

Background: Tumours of the female genital tract are often diagnosed at an advanced stage or re­lapse after initial curative therapy. Ovarian cancer is in particular associated with peritoneal carcinomatosis or local tumour progression entailing different intestinal complications. Material and Methods: Based on our own results and a systemic PubMed search, different intes­tinal complications in non-curable tumours of the female genital tract were defined and dif­fer­ent surgical and non-surgical therapeutic options were analysed. Results: Stenosis of the small bowel is often ­caused by direct infiltration of the tumour. Peritoneal carcinomatosis or postoperative abdominal adhesions may lead to an acute or even more ­often chronic recurrent obstruction. The rectum or sigmoid colon is in particular affected by stenosis caused by tumour masses within the pelvis, ­occurring fistulas or direct tumour infiltration which may lead to bleeding complications or a large bowel obstruction. Radiation-induced ab­dominal adhesions or stenosis of the small bowel as well as radiation-induced chronic proctocolitis are further common abdominal complications. Special attention with regard to a well balanced indication towards surgical, oncological or conservative management must be given in the palliative setting of the genital tract. Conclusion: In particular the dictum of “primum nihil nocere” has to be followed in consideration of the patient's declared intention, the patient’s prognosis, general condition, psychological strain as well as the expected complications. 

Schlüsselwörter

palliative Chirurgie - Ovarialkarzinom - Peritonealkarzinose - Ileus - Blutung - Strahlenschaden

Key words

palliative surgery - ovarian cancer - peritoneal carcinomatosis - bowel obstruction - bleeding - radiation injury

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