Plastische Chirurgie in der Palliation – Bericht des Consensus-Workshops im Rahmen der 37. Jahrestagung der Deutschsprachigen Gemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) 2015 in Bochum

Zusammenfassung

Einleitung: Im Consensus-Workshop „Plastische Chirurgie in der Palliation“ im Rahmen der 37. Jahrestagung der DAM 2015 in Bochum wurden gemeinsam mit Vertretern der Onkologie und Palliativmedizin Therapiemöglichkeiten palliativer Patienten eruiert und wesentliche Empfehlungen festgehalten.

Methode: Anhand einer Literaturrecherche und der Ergebnisse der Expertendiskussion werden die Therapiemöglichkeiten und -grenzen aufgezeigt und der Stellenwert der Plastischen Chirurgie für Patienten in Palliation herausgearbeitet sowie Empfehlungen für die Verbesserung der interdisziplinären Zusammenarbeit gegeben.

Ergebnisse: Eine sinnvolle Kombination von Chemotherapie und operativem Vorgehen, sowie die frühe Einbettung in ein palliatives Versorgungskonzept verlängern das Überleben und erhöhen die Lebensqualität von Patienten in der Palliativsituation.

Diskussion: Plastische Chirurgen sollten stets in Tumorboards präsent sein. Das Wissen um den Stellenwert plastisch-rekonstruktiver Eingriffe für die Verbesserung der Lebensqualität palliativer Patienten im multidisziplinären Therapiekonzept soll verbreitet werden. Wünschenswert wäre eine Beteiligung an der nächsten Leitlinienerstellung der Palliativmediziner. Sobald Patienten als palliativ eingestuft werden, soll der Palliativmediziner einbezogen werden.

Abstract

Introduction: At the consensus meeting on “Plastic Surgery in the Palliative Situation” at the 37th Annual Meeting of the DAM 2015 in Bochum, treatment options were discussed with oncologists and palliative care anesthesiologists and recommendations were given.

Methods: The literature was reviewed and the results of the expert-meeting options and limits of therapy were illustrated. The role of plastic surgery for palliative care patients was pointed out and recommendations given for successful cooperative treatment.

Results: A rational combination of chemotherapy and surgery as well as early integration into a palliative care concept prolongs survival and improves the quality of life of patients in the palliative situation.

Discussion: Plastic surgeons should regularily attend tumour boards to spread the knowledge of the value of reconstructive procedures in multidisciplinary treatment, in order to enhance the quality of live of the palliative patient. Participation in the preparation of the next treatment guidelines for palliative care would be desirable. Whenever patients are considered in a palliative situation, palliative care anesthesiologists should be involved.

Schlüsselwörter

Palliativmedizin - Onkologie - Plastische Chirurgie - Chemotherapie - Tumorkonferenz

Key words

palliative care - oncology - plastic surgery - chemotherapy - tumor board

• Literatur

• 1 [Anonym] ESMO Minimum Clinical Recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Annals of oncology: Official Journal of the European Society for Medical Oncology/ESMO 2001; 12: 1047-1048
• 2 Wang J, Shi M, Ling R et al. Adjuvant chemotherapy and radiotherapy in triple-negative breast carcinoma: a prospective randomized controlled multi-center trial. Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology 2011; 100: 200-204
• 3 Göhl J MS Palliative Metastasenchirurgie beim malignen Melanom. Zentralbl Chir 2010; 135: 516-522
• 4 Biganzoli L, Wildiers H, Oakman C et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). The lancet oncology 2012; 13: e148-e160
• 5 Inderbitzi R, Rolle A. Palliative surgery for primary and secondary thoracic malignancies. Therapeutische Umschau Revue therapeutique 2001; 58: 435-441
• 6 Ford-Dunn S. Use of vacuum assisted closure therapy in the palliation of a malignant wound. Palliative medicine 2006; 20: 477-478
• 7 Vogt PM, Ganser A, Karstens J. Plastisch-rekonstruktive Chirurgie: Palliative Therapie fortgeschrittener Weichgewebstumoren. Dtsch Ärztebl 2009; 106: 1776-1780
• 8 Daigeler A, Druecke D, Hakimi M et al. Reconstruction of the thoracic wall – long-term follow-up including pulmonary function tests. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 2009; 394: 705-715
• 9 Daigeler A, Lehnhardt M, Khadra A et al. Proximal major limb amputations – a retrospective analysis of 45 oncological cases. World journal of surgical oncology 2009; 7: 15
• 10 Daigeler A, Kuhnen C, Moritz R et al. Lymph node metastases in soft tissue sarcomas: a single center analysis of 1 597 patients. Langenbecks Arch Surg 2009; 394: 321-329
• 11 Daigeler A, Zmarsly I, Hirsch T et al. Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer 2014; 110: 1456-1464
• 12 Sepulveda C, Marlin A, Yoshida T et al. Palliative Care: the World Health Organization’s global perspective. J Pain Symptom Manage 2002; 24: 91-96
• 13 Temel JS, Greer JA, Muzikansky A et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733-742
• 14 Bakitas MA, Tosteson TD, Li Z et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the enable iii randomized controlled trial. J Clin Oncol 2015; 33: 1438-1445
• 15 Moss AH, Lunney JR, Culp S et al. Prognostic significance of the “surprise” question in cancer patients. J Palliat Med 2010; 13: 837-840
• 16 Kopetz S, Chang GJ, Overman MJ et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 2009; 27: 3677-3683
• 17 Verweij J, Casali PG, Zalcberg J et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet 2004; 364: 1127-1134
• 18 Bauer S, Rutkowski P, Hohenberger P et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib – Analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol 2014, doi:S0748-7983(14)00003-1 [pii]; doi:10.1016/j. ejso.2013.12.020
• 19 Brahmer J, Reckamp KL, Baas P et al. Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. N Engl J Med 2015; 373: 123-135
• 20 Vogt PM, Jokuszies A. Advanced malignant soft tissue tumors: plastic reconstructive options for palliative treatment. Chirurg 2010; 81: 1108-1114
• 21 Lee G, Anand SC, Rajendran S et al. Efficacy of commercial dressings in managing malodorous wounds. Br J Nurs 2007; 16 S14 S16, S18–20
• 22 Adderley U, Smith R. Topical agents and dressings for fungating wounds. Cochrane Database Syst Rev 2007; CD003948
• 23 Seaman S. Management of malignant fungating wounds in advanced cancer. Seminars in oncology nursing 2006; 22: 185-193
• 24 McNees P. Skin and wound assessment and care in oncology. Seminars in oncology nursing 2006; 22: 130-143
• 25 Venturi ML, Attinger CE, Mesbahi AN et al. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review. American Journal of Clinical Dermatology 2005; 6: 185-194
• 26 Miller M, Glover D. Wound Management: theory and practice. The Friary Press 1999
• 27 White RA, Miki RA, Kazmier P et al. Vacuum-assisted closure complicated by erosion and hemorrhage of the anterior tibial artery. Journal of orthopaedic trauma 2005; 19: 56-59
• 28 Chrisman CA. Care of chronic wounds in palliative care and end-of-life patients. International wound journal 2010; 7: 214-235
• 29 Schütte K, WJ Meyer F. et al. Palliativtherapie im Grenzgebiet zwischen Gastroenterologie und (Viszeral-)Chirurgie. Zentralbl Chir 2010; 135: 528-534
• 30 Angele M, KP Spelsberg F. et al. Inoperable Genitaltumoren der Frau: Therapeutische Optionen bei Darmstenose und -blutung. Zentralbl Chir 2011; 136: 237-243
• 31 Delgadillo X, MJ-S Solass W. et al. Stellenwert der Chirurgie in der palliativen Behandlung des Rektumkarzinoms. Zentralbl Chir 2010; 135: 523-527
• 32 Gerber B FM RT Rezidiviertes Mammakarzinom: Therapiekonzepte zum Erhalt der Lebensqualität. Dtsch Ärztebl Int 2010; 107: 85-91
• 33 Predina JD, Puc MM, Bergey MR et al. Improved survival after pulmonary metastasectomy for soft tissue sarcoma. J Thorac Oncol 2011; 6: 913-919
• 34 Stephens EH, Blackmon SH, Correa AM et al. Progression after chemotherapy is a novel predictor of poor outcomes after pulmonary metastasectomy in sarcoma patients. J Am Coll Surg 2011; 212: 821-826
• 35 Choong PF, Pritchard DJ, Rock MG et al. Survival after pulmonary metastasectomy in soft tissue sarcoma. Prognostic factors in 214 patients. Acta Orthop Scand 1995; 66: 561-568
• 36 Casson AG, Putnam JB, Natarajan G et al. Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 1992; 69: 662-668
• 37 Daigeler A, Harati K, Goertz O et al. Prognostic factors and surgical tactics in patients with locally recurrent soft tissue sarcomas. Handchir Mikrochir Plast Chir 2015; 47: 118-127
• 38 Venkatesan M, Richards CJ, McCulloch TA et al. Inadvertent surgical resection of soft tissue sarcomas. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2012; 38: 346-351
• 39 Lehnhardt M, Hirche C, Daigeler A et al. Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 2012; 83: 143-152