Conradi Lena-Christin, Ghadimi Michael
Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Chirurg. 2022 Mar;93(3):234-241. doi: 10.1007/s00104-022-01614-x. Epub 2022 Feb 24.
Oncological surgery is a discipline which closely interacts with other clinical partners and remains in many cases the cornerstone of a curative treatment of solid tumors. Due to the progress in the field of systemic tumor treatment as well as innovations in surgical techniques, the indications in oncological surgery are also changing, such as extended indications for patients with oligometastatic disease. Surgery of metastases has long been established for colorectal cancer and is being further tested for other entities, such as pancreatic and gastric cancer, within randomized controlled clinical trials (e.g. RENAISSANCE and METAPANC). A new challenge is the handling of a clinical complete remission after total neoadjuvant therapy, for example in locally advanced rectal cancer or in esophageal cancer. Here, organ and function preservation are increasingly propagated but should only be performed within clinical trials until stratification enables the identification of patients in whom this concept is oncologically safe. The personalized use of oncological surgery is dependent on the patient, the tumor and on the total multimodal concept.
肿瘤外科是一门与其他临床学科密切互动的学科,在许多情况下仍是实体瘤根治性治疗的基石。由于全身肿瘤治疗领域的进展以及手术技术的创新,肿瘤外科的适应证也在发生变化,例如寡转移疾病患者的适应证有所扩大。转移灶手术在结直肠癌中早已确立,并且正在针对其他实体瘤(如胰腺癌和胃癌)在随机对照临床试验(如RENAISSANCE和METAPANC)中进行进一步测试。一个新的挑战是处理全新辅助治疗后的临床完全缓解,例如局部晚期直肠癌或食管癌。在此,器官和功能保留的理念日益受到推崇,但在分层能够确定该概念在肿瘤学上安全的患者之前,应仅在临床试验中进行。肿瘤外科的个性化应用取决于患者、肿瘤以及整体多模式治疗理念。