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Palliativchirurgie in der Viszeralmedizin

Am Beispiel des kolorektalen und des Magenkarzinoms

Palliative surgery in visceral medicine

Exemplified by colorectal and gastric cancer

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Zusammenfassung

Hintergrund

Der Stellenwert einer Primärtumorresektion in der metastasierten, palliativen Situation wird kontrovers diskutiert. Daten liegen nahezu ausschließlich aus retrospektiven Analysen vor. Prospektiv randomisierte erhobene Studienergebnisse existieren bisher nicht.

Ziel der Arbeit

Am Beispiel des Magen- und des Rektumkarzinoms werden Ergebnisse einer prospektiven Observationsstudie zur palliativen Primärtumorresektion vorgestellt und im Literaturvergleich diskutiert.

Methode

Basierend auf den am „An-Institut für Qualitätssicherung in der operativen Medizin“ der Otto-von-Guericke-Universität Magdeburg erhobenen Daten der prospektiven Observationsstudien „Qualitätssicherung Rektum-Karzinom“ und „Qualitätssicherungsstudie Magenkarzinom“ wurden die onkologischen Langzeitergebnisse nach palliativer Primärtumorresektion beim UICC-IV-Rektumkarzinom (2005–2008; n = 2046 Patienten) und nach palliativer Magenresektion (2007–2009; n = 687 Patienten) analysiert und mit Literaturdaten verglichen.

Ergebnisse

Nach palliativer Primärtumorresektion beim UICC-IV-Rektumkarzinom betrug die mediane Überlebenszeit der analysierten Patienten 20 Monate. Für Patienten mit hepatischer Metastasierung und Metastasenresektion wurde ein medianes Überleben von 38 Monaten erreicht, wenn der Primärtumor zudem keine Lymphknotenmetastasierung aufwies, sogar von 58 Monaten. Beim Magenkarzinom zeigten sowohl Patienten mit palliativer Tumorresektion (R2) als auch nichtresezierte Patienten einen prognostischen Vorteil, wenn eine palliative Chemotherapie durchgeführt werden konnte. Patienten mit Primärtumorresektion und anschließender palliativer Chemotherapie zeigten ein signifikant längeres medianes Überleben (11 Monate) als Patienten ohne Primärtumorresektion bei alleiniger palliativer Chemotherapie (medianes Überleben 7 Monate; p < 0,001).

Diskussion

Ausgehend von den vorgestellten Ergebnissen der Beobachtungsstudien zum Rektum- und Magenkarzinom lassen sich unter Berücksichtigung vorliegender Literaturergebnisse prognostische Vorteile durch eine palliative Primärtumorresektion ableiten.

Abstract

Background

The benefits of primary tumor resection in metastatic disease remains a matter of debate. Existing data are almost exclusively limited to results from retrospective analyses. Data from prospective, randomized trials are currently not available.

Aim

The results from two prospective observational studies involving gastric and rectal cancer patients are presented and discussed in the context of the available literature.

Method

Based on data collected within the prospective quality assurance studies on gastric and rectal cancer conducted by the Institute for Quality Assurance in Surgery at Otto von Guericke University, Magdeburg, Germany, the long-term outcome after palliative primary tumor resection in patients with International Union Against Cancer (UICC) stage IV rectal cancer (2005–2008, n = 2046) and metastatic gastric cancer (2007–2009, n = 687) was analyzed and compared to published data.

Results

The median survival time following palliative primary tumor resection of UICC stage IV rectal cancer in the patients analyzed was 20 months. In patients with hepatic metastases undergoing metastasectomy the median survival was 38 months. This increased to 58 months for patients with lymph node negative primary tumors. In metastatic gastric cancer patients undergoing palliative (R2) gastric resection and also patients not undergoing surgery showed a prognostic benefit from palliative chemotherapy; however, the median survival time was significantly prolonged if palliative chemotherapy was preceded by resection of the primary tumor (11 versus 7 months, p < 0.001).

Discussion

Together with previously published data, the results from the two observational studies on rectal and gastric cancer presented here suggest a prognostic benefit from palliative resection of the primary tumor in metastatic disease.

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Authors and Affiliations

  1. Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, ZENIT II – Gebäude, 39120, Magdeburg, Deutschland

    H. Ptok, I. Gastinger & H. Lippert

  2. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, Haus 60a, 39120, Magdeburg, Deutschland

    H. Ptok, S. Wolff & C. Bruns

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  1. H. Ptok
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Correspondence to H. Ptok.

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H. Ptok, I. Gastinger, S. Wolff, C. Bruns und H. Lippert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Ptok, H., Gastinger, I., Wolff, S. et al. Palliativchirurgie in der Viszeralmedizin. Chirurg 87, 216–224 (2016). https://doi.org/10.1007/s00104-015-0148-z

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