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Der Onkologe

, Volume 25, Issue 2, pp 123–130 | Cite as

Operative Therapie des frühen und fortgeschrittenen Ovarialkarzinoms

  • Jalid SehouliEmail author
  • Matthias Biebl
  • Robert Armbrust
Leitthema
  • 63 Downloads

Zusammenfassung

Hintergrund

Die operative Therapie des Ovarialkarzinoms ist neben der systemischen Therapie ein grundlegender Pfeiler in der Behandlungsstrategie. Grundsätzlich hat die Operation eine duale Bedeutung: Sie dient zum einen als Grundlage des FIGO-Stagings und ist demnach die wichtigste diagnostische Methode. Andererseits hat sie unmittelbaren Einfluss auf die Prognose und ist Teil eines meist multimodalen und interdisziplinären Therapiekonzepts beim primären Ovarial‑, Tuben- und Peritonealkarzinom.

Ergebnisse

Während es sich in den frühen Stadien bis FIGO IIA mehrheitlich um Komplettierungs- sowie Staging-Operationen handelt, sollte das Ziel der Operation beim fortgeschrittenen Karzinom die maximale Tumorreduktion sein, häufig verbunden mit der Notwendigkeit multiviszeraler Eingriffe. Das operative Staging im Frühstadium bis FIGO IIA sollte adäquat sowie komplett durchgeführt werden und definierte Operationsschritte beinhalten. Da der verbleibende, makroskopisch sichtbare Tumorrest ein entscheidender Prognosefaktor für das Gesamtüberleben ist, sollte das Ziel der Operation im fortgeschrittenen Stadium immer eine makroskopische Komplettresektion sein. Bei Patientinnen mit fortgeschrittenem Ovarialkarzinom ab dem Stadium FIGO IIIC sollte bei klinisch unauffälligen Lymphknoten und einer makrokoskopischen Komplettresektion auf eine systematische pelvine und paraaortale Lymphonodektomie unbedingt verzichtet werden. Die primäre Operation gilt auch in der aktuellen interdisziplinär und interprofessionell abgestimmten S3-Leitlinie als Standardtherapie. Methoden wie PIPAC oder HIPEC sollten nicht außerhalb klinischer Studien zur Anwendung kommen.

Diskussion

Der postoperative Tumorrest ist der entscheidendste Prognosefaktor für das progressionsfreie und Gesamtüberleben. In den Frühstadien sollte ein adäquates Staging erfolgen, wohingegen in den häufigeren fortgeschrittenen Stadien multiviszerale Resektionen erforderlich sind, welche eine interdisziplinäre Zusammenarbeit erforderlich machen.

Schlüsselwörter

FIGO-Staging Staging- und Komplettierungsoperation Debulking-Operation PIPAC HIPEC 

Operative treatment of early and advanced ovarian cancer

Abstract

Background

Primary debulking surgery is the main treatment for ovarian cancer besides chemotherapy and possible targeted therapies. Principally, surgery has two different purposes: on the one hand primary surgery is the foundation of FIGO staging and is therefore the most important diagnostic instrument. On the other hand it has a direct and strong influence on the prognosis and is part of a mostly multimodal and interdisciplinary treatment concept for primary ovarian, fallopian and peritoneal cancer.

Results

In the early stages (up to FIGO IIA) the goal of ovarian cancer surgery is an adequate staging; however, the main goal in advanced stages is maximum tumor reduction with the aim of achieving a complete resection with no macroscopically visible residual tumor. In patients with advanced ovarian cancer above FIGO IIIC, systematic para-aortic and pelvic lymphadenectomy of clinically negative lymph nodes and complete resection should be omitted. Despite several publications in recent years regarding the optimal timing of surgery (interval debulking after neoadjuvant chemotherapy or primary debulking surgery), primary up front debulking remains the standard procedure in primary ovarian cancer also in the current interdisciplinary and interprofessional consensus S3 guidelines. Methods such as PIPAC and HIPEC should be classified as experimental and should only be performed within clinical trials.

Discussion

The macroscopic residual tumor is the most important factor for progression-free and overall survival. In early stage disease adequate and complete staging is mandatory whereas in advanced stages multivisceral resections often become necessary Therefore, complex interdisciplinary surgery should be planned and performed. The optimal timing of debulking surgery still remains a controversial issue and cannot finally be answered at the moment so that primary surgery still represents the first step.

Keywords

FIGO-Staging Staging surgery Debulking surgery PIPAC HIPEC 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Sehouli, M. Biebl und R. Armbrust geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Jalid Sehouli
    • 1
    Email author
  • Matthias Biebl
    • 2
  • Robert Armbrust
    • 1
  1. 1.Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Europäisches Kompetenzzentrum für Eierstockkrebs (EKZE)Charité Universitätsmedizin BerlinBerlinDeutschland
  2. 2.Chirurgische KlinikCharité Universitätsmedizin BerlinBerlinDeutschland

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