Chirurgische Ansätze zur Prävention bei gastrointestinalen Tumoren

Zusammenfassung

Über viele Jahrzehnte kam die chirurgische Therapie bei Tumoren des Gastrointestinaltraktes nur im manifesten Erkrankungszustand unter kurativer oder palliativer Intention zum Einsatz. Die molekulare Diagnostik führte in den letzten 20 Jahren zu einer optimierten Charakterisierung unterschiedlicher sporadischer und hereditärer Tumorerkrankungen. Weiterhin ist eine Anzahl von Erkrankungen bekannt, die obligate Präkanzerosen darstellen oder im Laufe ihrer langen Erkrankungsdauer ein hohes Entartungsrisiko aufweisen. Parallel hierzu hat die Viszeralchirurgie durch subtilere und blutsparende Operationstechnik eine dramatische Reduktion der Morbidität erreicht und die Mortalität selbst bei größten Eingriffen auf ein Minimalmaß reduziert. Diese Kombination erlaubt heute die Durchführung präventiver oder präventiv erweiterter chirurgischer Maßnahmen, wo die interventionelle Therapie nicht erfolgreich durchführbar ist.

Abstract

Over many decades the surgical treatment of gastrointestinal tumours was limited to cases of manifest malignancy and was performed with curative or palliative intent. Molecular diagnostics have now led to an optimised characterisation of different sporadic and hereditary tumour entities. Furthermore, a number of diseases which are an obligatory precancerosis or which carry a very high risk of cancer in their long courses have now been identified. Parallel to these developments, a dramatic reduction of morbidity has been achieved in major abdominal surgery due to more subtle and blood-sparing surgical techniques and mortality has been reduced to a minimum even in the most major procedures. This combination nowadays safely allows preventive or preventive extended surgical measures in cases where interventional therapy cannot be adequately employed.

Schlüsselwörter

Chirurgie - chirurgische Prävention - gastrointestinale Tumoren - HNPCC - FAP - Colitis ulcerosa - chronische Pankreatitis - Präkanzerosen

Key words

Surgery - surgical prevention - gastrointestinal tumours - HNPCC - FAP - ulcerative colitis - chronic pancreatitis - precancerosis

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