Peritoneale Metastasen: Wann lohnt die Chirurgie und intraperitoneale Chemotherapie?

Zusammenfasssung

Bei ca. 10 % der Patienten mit gastrointestinalen Malignomen besteht bereits zum Diagnosezeitpunkt eine Peritonealkarzinose. Bei Fehlen einer Fernmetastasierung kann diese durchaus als regionale Metastasierung interpretiert werden, die nicht grundsätzlich zu therapeutischem Nihilismus führen sollte. In den vergangenen Jahren haben deshalb multimodale Behandlungskonzepte, bestehend aus maximal zytoreduktiver Chirurgie kombiniert mit intraoperativer, hyperthermer intraperitonealer Chemotherapie Bedeutung erlangt. Unter Berücksichtigung des eigenen Patientenkollektives (n = 62) im Zeitraum 1995-05/2004 werden die diesem Konzept zugrunde liegenden Überlegungen dargestellt. Bei einer im Verlauf abnehmenden Morbidität sowie einem geringen Anteil von chirurgischen Komplikationen kann dieses Therapiekonzept in spezialisierten Zentren einen kurativen Therapieansatz darstellen.

Abstract

About 10 % of patients with gastrointestinal malignancies suffer from peritoneal carcinomatosis at the time of first diagnosis. In case of absence of lesions in liver or lung, this can be interpreted as local metastasis and therefore should not lead to “therapeutical Nihilism”. In the last years multimodal therapies were established, i. e. maximal cytoreductive surgery combined with intraoperative hyperthermic intraperitoneal chemotherapy. In analyzing 62 patients from 1995-2004, the rationale of this concept and the surgical technique are described and discussed. In specialized centers the morbidity and mortality rates of these procedures are significantly reduced; thus this concept can be considered as a curative therapy regimen.

Schlüsselwörter

Peritonealkarzinose - Pseudomyxoma peritonei - Indikation multiviszerale Resektion - Intraperitoneale Chemotherapie

Key words

Peritonealcarcinosis - pseudomyxoma peritonei - indication for multivisceral resection - intraperitoneal chemotherapy

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