Selektion zur Peritonektomie mit hyperthermer intraoperativer Chemotherapie (HIPEC) bei Peritonealkarzinose

Zusammenfassung

Einleitung: Die Peritonektomie mit hyperthermer intraoperativer Chemotherapie (HIPEC) etabliert sich zunehmend als Therapieoption bei Patienten mit peritoneal metastasierten gastrointestinalen und gynäkologischen Tumoren sowie primären peritonealen Malignomen. Um unnötige Operationen zu vermeiden, sind verlässliche Selektionskriterien unerlässlich. Methoden: Anhand einer Literaturübersicht und eigener Erfahrungen werden Selektionskriterien diskutiert, präoperativ die Operabilität abzuschätzen. Resultate: Die Computertomografie (CT) und die explorative Laparoskopie sind für die Evaluierung einer Peritonealkarzinose unzureichend. Die diagnostische Genauigkeit kann durch die Kombination der Fluor-Deoxyglukose-Positronen-Emissions-Tomografie (FDG-PET) mit dem CT verbessert werden und ist wesentlicher Bestandteil des eigenen diagnostischen Algorithmus. Schlussfolgerung: Das PET / CT gilt in unseren Händen derzeit wohl als sicherstes nicht invasives Verfahren zur Abschätzung der Operabilität. 

Abstract

Background: Cytoreductive peritonectomy with hyperthermic intraoperative chemotherapy (HIPEC) is an established therapy for patients with gastrointestinal, gynaecological metastasised peritoneal carcinomatosis as well as primary peritoneal carcinomatous tumours. Methods: On the basis of a literature review and our personal experience, selection criteria for peritonectomy are discussed. Results: Computed tomography (CT) scans and diagnostic laparoscopy are not sufficient for the diagnosis of peritoneal carcinomatosis. The combination of fluorodeoxyglucose positron emission tomography (FDG-PET) and CT seems to be the most reliable diagnostic imaging method. In our institution, all patients undergo PET / CT prior to peritonectomy. Conclusion: The PET / CT scan may play an important role in forecasting the operability of patients with peritoneal carcinomatosis. 

Schlüsselwörter

Peritonealkarzinose - Selektionskriterien - PET / CT - präoperative Evaluation

Key words

peritoneal carcinomatosis - selection criteria - preoperative evaluation - PET / CT scan

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