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Peritonealkarzinose Beim Magenkarzinom

Arnd Brandl, Faik Güntac Uzunoglu, Yogesh Kumar Vashist
Published 2016 · Medicine
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ZusammenfassungHintergrundDas Magenkarzinom weist eine Inzidenz von 24,2 Neuerkrankungen pro 100.000 Einwohner (Krebsregister 2011) in Deutschland auf. Bei ca. 15 % der Patienten kann zum Zeitpunkt der Erstdiagnose bereits eine Peritonealkarzinose nachgewiesen werden.FragestellungFür Patienten mit einem pertinoneal metastasierten Magenkarzinom kann die Möglichkeit einer zytoreduktiven Therapie und hyperthermen intraperitonealen Chemoptherapie (HIPEC) evaluiert werden. Welche Patienten für diese Therapie in Frage kommen und zu welchen Ergebnissen die zytoreduktive Chirurgie (CRS) und HIPEC führen kann, soll im Folgenden erläutert werden.Material und MethodeEs wurde eine systematische Überprüfung der Literatur vorgenommen, mit Erarbeitung der Kriterien für Patienten, die für eine zytoreduktive Therapie mit HIPEC infrage kommen sowie der Herausarbeitung der Ergebnisse mit kurzem Ausblick über mögliche zukünftige Therapievarianten.ErgebnisseDer wichtigste Prognosefaktor für Patienten mit peritoneal metastasiertem Magenkarzinom ist die Möglichkeit einer kompletten Zytoreduktion. Durch eine multimodale Therapie, bestehend aus Chemotherapie, CRS und HIPEC, kann das mediane Überleben in einem selektionierten Patientengut signifikant gesteigert werden.SchlussfolgerungenWegweisend für die Verbesserung des Patientenüberlebens ist die Patientenselektion im Rahmen einer multidisziplinären Gruppe von Spezialisten (Chirurg, Onkologe und Intensivmediziner), um ein optimales Therapieergebnis (komplette Zytoreduktion) für den einzelnen Patienten zu erreichen. Im onkologischen Setting ist eine neoadjuvante und adjuvante Chemotherapie sinnvoll, um die Rate an kompletten Zytoreduktionen zu verbessern und wohlmöglich die rezidivfreie Überlebenszeit und Gesamtüberlebenszeit zu verlängern.AbstractBackgroundThe incidence of gastric cancer in Germany is 24.2 per 100,000 inhabitants per year (cancer registry 2011) and in 15 % of these patients peritoneal carcinomatosis is simultaneously detected at the time of the primary diagnosis.ObjectivePatients with peritoneal carcinomatosis due to metastases from gastric cancer should be evaluated for the possibility of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The indications and outcome for cytoreductive surgery and HIPEC are discussed in this paper.MethodsThe study included a systematic review of the literature and development of criteria which simplify the decision of patient selection for cytoreductive surgery and HIPEC. This review highlights the patient outcome and outlines possible future diagnostic and therapeutic options.ResultsCompleteness of cytoreductive surgery is the most important prognostic factor for patients with peritoneal carcinomatosis from metastasized gastric cancer. The median survival time can be significantly prolonged in selected patients from 1–3 months to 11 months using a multimodal therapeutic regimen including chemotherapy, cytoreductive surgery and HIPEC.ConclusionTo achieve an optimal outcome (complete cytoreduction) with improvement in patient survival, patient selection performed by a multidisciplinary group of specialists (e.g. surgeon, oncologist and anesthesiologist) is crucial. Neoadjuvant and adjuvant chemotherapy is generally recommended in order to achieve an improved rate of complete cytoreduction and to potentially prolong disease-free and overall survival times.
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