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TumorDiagnostik & Therapie 2017; 38(05): 323-329
DOI: 10.1055/s-0043-103975
Thieme Onkologie aktuell
© Georg Thieme Verlag KG Stuttgart · New York

Aktueller Stand Salvage-chirurgischer Therapiekonzepte bei Rezidivtumoren des Larynx und Pharynx

The current role of salvage-surgery of recurrent tumors in the larynx and pharynx
B. A. Stuck
1   Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
,
N. Rothmeier
2   HNO-Gemeinschaftspraxis, Gelsenkirchen
,
S. Mattheis
1   Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
,
N. Dominas
1   Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
,
S. Lang
1   Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
› Author Affiliations
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Publication History

Publication Date:
08 June 2017 (online)

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Zusammenfassung

Die therapeutischen Konzepte bei Kopf-Hals-Malignomen haben in den letzten 20 Jahren einen erheblichen Wandel erfahren, der mit einer zunehmenden Bedeutung nicht-chirurgischer Therapieverfahren einhergeht. Auch unter den Organerhaltungsprotokollen bzw. nach primärer Radiochemotherapie kommt es jedoch in erheblichem Umfang zum Auftreten von Tumorrezidiven. In dieser Situation stellt die Salvage- bzw. Rettungschirurgie im Kopf-Hals-Bereich häufig die einzig noch verbliebene kurative Option dar. Die Etablierung plastisch-rekonstruktiver Maßnahmen vor ca. 30 Jahren hat das operative Spektrum im Kopf-Hals-Bereich signifikant erweitert und neue Möglichkeiten der Salvage-Chirurgie bei rezidivierenden Karzinomen des Pharynx und Larynx eröffnet. Die Überlebensraten nach Salvage-Chirurgie hängen hierbei im Wesentlichen von der Art der Primärtherapie, der Lokalisation und dem Tumorstadium sowohl bei Erstdiagnose als auch zum Zeitpunkt des Rezidivs ab. Zur plastisch-rekonstruktiven Deckung kommen gestielte Lappen oder mikrovaskulär-anastomosierte Transplantate zum Einsatz. Die am häufigsten angewandten gestielten Lappen sind der M. pectoralis-major- und der Latissimus-dorsi-Lappen. Als freie Transplantate kommt meist das Radialis- oder ALT-Transplantat zum Einsatz. Durch Verwendung dieser Lappen und Transplantate wird nicht-bestrahltes Gewebe in die vorgeschädigten Regionen verlagert, um neben der Wiederherstellung der ursprünglichen Organfunktion auch gefürchtete postoperative Komplikationen, wie z. B. Speichelfisteln, zu reduzieren. Die Indikation zur Salvage-Chirurgie muss auch weiterhin in jedem Einzelfall vor dem Hintergrund der zu erwartenden Morbidität und einer realistischen Einschätzung der Erfolgsaussichten abgewogen werden. Die vorliegende Publikation möchte hierzu entsprechende Empfehlungen geben.

Abstract

Over the past 20 years, the therapeutic concepts for the treatment of head and neck cancer have evolved and non-surgical treatment strategies have gained in importance. However, despite improved organ preservation protocols and primary chemoradiation, tumor recurrence is still frequent. Under these conditions, salvage surgery if often the only remaining curative treatment option. Over the past 30 years, advancements in plastic-reconstructive surgery have broadened the surgical spectrum in the head and neck area, offering new treatment options for salvage surgery in recurrent cancer of the pharynx and larynx. Survival after salvage surgery mainly depends on the primary treatment modality as well as the localization and tumor stage at the time of initial diagnosis and local recurrence. For the reconstruction of defects after salvage surgery, pedicled flaps and microvascular free flaps may be utilized. The most frequently used flaps in these situations are the pectoralis major island- or the myocutaneous latissimus dorsi island flap. The radial forearm and the ALT-flap are potentially applicable free flaps. With the use of these flaps, vital tissue is transferred into the previously irradiated area, hereby allowing for reconstruction and functional preservation of the resected area and preventing complications such as fistulas. The expected morbidity and the likelihood of surgical success must be assessed thoroughly in every individual case prior to performing salvage surgery. This review aims to support decision making in these situations.

Schlüsselwörter

Kopf-Hals-Tumor - Karzinom - Salvage-Chirurgie - Laryngektomie - Larynx - Oropharynx - Hypopharnyx

Key words

head and neck - carcinoma - salvage surgery - laryngectomy - oropharynx - hypopharynx
 

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