Zusammenfassung
Hintergrund: Aufgrund des Fehlens fester anatomischer Kompartimente werden retroperitoneale Sarkome
erst bei Vorliegen sehr großer Tumoren und Infiltration von Nachbarorganen diagnostiziert.
Trotz Fortschritte der diagnostischen Möglichkeiten und chirurgischer Techniken kommt
es auch nach kompletter Entfernung sehr häufig zu Lokalrezidiven mit ungünstiger Prognose.
Ziel dieser Arbeit war die Analyse von Diagnostik, Therapie und Langzeitverlauf der
retroperitonealen Sarkome im eigenen Krankengut über einen Zeitraum von 10 Jahren.
Patienten und Methodik: Zwischen Januar 1995 und Januar 2005 wurde in unserer Klinik bei 379 Patienten ein
operativer Eingriff wegen eines primären retroperitonealen Tumors durchgeführt. Unter
den 67 (17,7 %) malignen Läsionen fand sich bei 35 Patienten ein Sarkom. Die vorliegende
Untersuchung berücksichtigt den Langzeitverlauf der 21 Patienten mit primärem reseziertem
retroperitonealem Sarkom, Rezidiveingriffe und Probelaparotomien ausgeschlossen. Ergebnisse: Das mediane Alter zum Zeitpunkt der Operation war 61 (25-86) Jahre, 57,1 % aller
Patienten waren männlich. Die Dauer der Symptome betrug 3 (1-36) Monate. Eine pR0-Resektion
konnte bei 20/21 Patienten erreicht werden. Unter den histopathologischen Tumortypen
fanden sich am häufigsten Liposarkome (n = 10) und Leiomyosarkome (n = 6). Bei 12
von 21 Patienten kam es im Median 13,5 (5-42) Monate nach dem Ersteingriff zu einem
Lokalrezidiv, bei 4 Patienten zu Fernmetastasen. Das Langzeitüberleben aller 21 Patienten
mit primärem reseziertem retroperitonealem Sarkom betrug 24 (1-101) Monate. Dabei
fanden sich günstigere Verläufe für Patienten mit Leiomyosarkom verglichen mit den
Liposarkomen. Schlussfolgerung: Retroperitoneale Sarkome sind eine heterogene Entität und fanden sich im eigenen
Krankengut bei 6,1 % aller primärer, operativ behandelter retroperitonealer Tumoren.
Die Behandlungsstrategie ist komplex und abhängig von Stadium, Lokalisation und histologischen
Charakteristika. Das Langzeitüberleben ist limitiert durch die hohe Rate an Lokalrezidiven.
Abstract
Background: Due to the fact that there are no distinct anatomical compartments, retroperitoneal
sarcomas are moreover diagnosed with evidence of large tumors and infiltration of
adjacent organs. In spite of improvement of the diagnostic facilities and surgical
techniques, quite frequently local recurrences with unfavourable prognosis turn up
even after complete removal. It was the aim of this study to analyze diagnosis, therapy
and long-term prognosis in patients with retroperitoneal sarcomas over a period of
10 years. Patients and Methods: Between January 1995 and January 2005, 379 patients underwent surgery for a primary
retroperitoneal tumor at our clinic. Among the 67 (17.1 %) malignant lesions, a sarcoma
was found in 35 patients. The present study is focused on the long-term prognosis
of those 21 patients with a primary resected retroperitoneal sarcoma, recurrent sarcomas
and exploratory laparotomies excluded. Results: The median patient age at the time of surgery was 61 (25-86) years, 57.1 % were males.
The duration of symptoms was 3 (1-36) months. A pR0-resection was achieved in 20/21
patients. Among the histopathological tumor types, liposarcomas (n = 10) and leiomyosarcomas
(n = 6) were found most frequently. Local recurrence developed in 12 out of 21 patients
at 13.5 (5-42) months after the first operation, and in 4 patients distant metastases
were observed. The long-term survival of all 21 patients with primary resected retroperitoneal
sarcoma was 24 (1-101) months. A more favourable prognosis was seen in patients with
leiomyosarcoma as compared with liposarcoma. Conclusion: Retroperitoneal sarcomas are a heterogeneous entity, and they were found among our
own patients in 6.1 % of all primary operatively treated retroperitoneal tumors. The
strategy of treatment is complex and dependent on the stage, localization and histopathological
characteristics. Long-term survival is limited as a result of the high rate of local
recurrence.
Schlüsselwörter
retroperitoneale Sarkome - Differenzialdiagnostik - operatives Vorgehen - Langzeitverlauf
Key words
retroperitoneal sarcoma - differential diagnostic - operative procedure - long-term
course
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Dr. med. Ines Gockel
Klinik für Allgemein- und Abdominalchirurgie · Johannes-Gutenberg-Universität
Langenbeckstr. 1
55101 Mainz
Telefon: +49/(0)61 31/17 72 91
Fax: +49/(0)61 31/17 66 30
eMail: gockel@ach.klinik.uni-mainz.de
