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Morbidität und Letalität der hyperthermen intraperitonealen Chemoperfusion

Morbidity and mortality of hyperthermic intraperitoneal chemoperfusion

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Zusammenfassung

Moderne Therapiekonzepte in der Behandlung der Peritonealkarzinose unterschiedlicher Malignome sehen neben dem systemischen Einsatz neuerer Chemotherapeutika auch in selektierten Fällen die Durchführung zytoreduktiver operativer Maßnahmen in Kombination mit einer hyperthermen intraperitonealen Chemoperfusion (HIPEC) vor. Aufgrund der teilweise relativ hohen peri- und postoperativer Morbidität und Letalität, wird nach aktuellem Kenntnisstand eine Lernkurve von mindestens 100 bis 150 Prozeduren gefordert.

Durch die Optimierung der bestehenden logistischen Voraussetzungen, einer sorgfältigen Vorbereitung und einer systematischen Schulung des ärztlichen und pflegerischen Personals gelingt es, perioperative Risiken und somit die Komplikationsraten nachhaltig zu senken. Diese komplexe Prozedur sollte vorzugsweise in spezialisierten Zentren durchgeführt werden.

Abstract

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a treatment option for peritoneal surface malignancy. Despite the survival benefits, this treatment was previously associated with a high morbidity and mortality rates, and the perception of the poor perioperative outcomes associated with this regimen remains. Careful patient selection with an optimal level of postoperative care must be advocated to avoid undesirable complications of this treatment.

However, for this treatment to be accepted as standard of care, teams undertaking this treatment strategy must aim to minimize morbidity and mortality by learning from the experience of established centers and using the “global learning curve”. The HIPEC Registry and accreditation of centers will improve the quality of the treatment.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J.O.W. Pelz und C.-T. Germer geben an, dass kein Interessenskonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Julius Maximilians Universität Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    J.O.W. Pelz & C.-T. Germer

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  2. C.-T. Germer
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Correspondence to J.O.W. Pelz.

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Pelz, J., Germer, CT. Morbidität und Letalität der hyperthermen intraperitonealen Chemoperfusion. Chirurg 84, 957–961 (2013). https://doi.org/10.1007/s00104-013-2513-0

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