Berger A K, Jäger D
Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland.
Chirurg. 2013 Nov;84(11):930-6. doi: 10.1007/s00104-013-2512-1.
Systemic chemotherapy, targeted therapies and radiotherapy for patients with malignant tumors lead to unfavorable surgical conditions with increased risks of postoperative complications. For gastric cancer and cancer of the esophagogastric junction, surgery after neoadjuvant treatment is associated with a mortality of approximately 5 %. Given the increase in metastatic surgery for colorectal carcinoma, surgeons should be aware of the specific side effects of therapeutic drugs to ensure an optimal course of treatment. The impact of chemotherapy-induced hepatic lesions on postoperative development is unclear. Bevacizumab treatment should be stopped at least 5 weeks before surgery to reduce the risk of thromboembolic events, bleeding and wound healing complications. Immunosuppressive and immunomodulating agents alter wound healing and preoperative alterations should be carefully evaluated. For patients with chronic corticosteroid therapy, perioperative supplementation should be considered when planning surgery as well as routine dosages.
针对恶性肿瘤患者的全身化疗、靶向治疗和放疗会导致手术条件不佳，术后并发症风险增加。对于胃癌和食管胃交界癌，新辅助治疗后进行手术的死亡率约为5%。鉴于结直肠癌转移手术的增加，外科医生应了解治疗药物的特定副作用，以确保最佳治疗过程。化疗引起的肝脏病变对术后恢复的影响尚不清楚。贝伐单抗治疗应在手术前至少5周停止，以降低血栓栓塞事件、出血和伤口愈合并发症的风险。免疫抑制和免疫调节药物会改变伤口愈合，术前改变应仔细评估。对于接受慢性皮质类固醇治疗的患者，在计划手术时应考虑围手术期补充以及常规剂量。
