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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Dr. Peter Mai
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie · Zentrum Chirurgie · Henriettenstiftung
Marienstraße 72-90
30171 Hannover
Phone: 05 11-2 89 21 01
Fax: 05 11-2 89 20 22
Email: Peter.Mai@Henriettenstiftung.de