Skip to main content
SpringerLink
Log in

Spätfolgen nach onkologischer Chirurgie

Long-term sequelae after oncological surgery

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Die onkologische Chirurgie erfordert oft ausgedehnte und radikale Eingriffe, die mit einem breiten Spektrum möglicher operationsbedingter Spätfolgen einhergehen.

Ziel der Arbeit

Dieser Übersichtsartikel soll wesentliche Spätfolgen onkologischer Chirurgie zusammenfassen und Präventions- und Therapieansätze aufzeigen. Beispielhaft werden Spätfolgen viszeralonkologischer Operationen am oberen und unteren Gastrointestinaltrakt sowie am Pankreas diskutiert.

Methoden

Es erfolgte eine selektive Literaturrecherche und Zusammenfassung der aktuellen Evidenz.

Ergebnisse

Das Erreichen des bestmöglichen onkologischen Ergebnisses geht häufig mit einer erhöhten postoperativen Morbidität sowie bleibenden Funktionseinschränkungen und permanenten Einbußen der Lebensqualität einher. Spätfolgen sind oft spezifisch für den jeweiligen Eingriff, wobei chronische Schmerzsyndrome und eine eingeschränkte gesundheitsbezogene Lebensqualität mit hoher Prävalenz organ- und eingriffsübergreifend auftreten. Häufige Spätfolgen nach onkologischer Chirurgie des oberen Gastrointestinaltrakts sind persistierende Beschwerden bei der Nahrungsaufnahme, postprandiale Störungen sowie respiratorische Einschränkungen. Nach Eingriffen am Pankreas steht aufgrund des Parenchymverlusts die endokrine- und exokrine Pankreasinsuffizienz im Vordergrund. Im Bereich des unteren Gastrointestinaltrakts sind persistierende Stuhlveränderungen, Defäkationsprobleme, Anastomosen- und Stomakomplikationen sowie Störungen der Blasen- und Sexualfunktion von Relevanz.

Schlussfolgerung

Herausforderung der onkologischen Chirurgie ist es, die Balance zwischen erforderlicher Radikalität und postoperativer Morbidität zu finden.

Abstract

Background

Oncological surgery often requires extensive and radical procedures leading to a wide range of possible long-term sequelae.

Objective

This overview article aims to summarize potential long-term complications of oncological surgery, including different approaches for prevention and treatment. Using examples, late sequelae of visceral oncological surgery to the upper and lower gastrointestinal tract and pancreas will be discussed.

Methods

A selective literature search was performed to summarize current evidence.

Results

Achieving the best possible oncological outcome is often associated with increased postoperative morbidity as well as permanent functional impairment and loss of quality of life. Long-term sequelae after oncological surgery are usually procedure specific. Chronic pain syndromes and reduced health-related quality of life occur with a high prevalence across all organs and procedures. Frequent long-term consequences after oncological surgery to the upper gastrointestinal tract are persistent complaints related to food intake, postprandial disorders, and respiratory difficulties. Due to loss of parenchyma, endocrine and exocrine pancreatic insufficiency are the leading sequelae after pancreatic surgery. In the lower gastrointestinal tract, surgical procedures can lead to persistent changes in stool consistency and frequency, problems in defecation, anastomotic and stoma complications, as well as bladder and sexual dysfunction.

Conclusion

The key challenge in oncological surgery is to find a balance between the required radicality and postoperative morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Gnant M, Schlag PM (2009) Chirurgische Onkologie: Strategien und Standards für die Praxis. Springer, Vienna

    Google Scholar 

  2. Siewert JR, Rothmund M, Schumpelick V (2010) Praxis der Viszeralchirurgie Onkologische Chirurgie, 3. Aufl. Springer, Berlin Heidelberg, Berlin, Heidelberg

    Book  Google Scholar 

  3. Silver J, Mayer RS (2007) Barriers to pain management in the rehabilitation of the surgical oncology patient. J Surg Oncol 95(5):427–435. https://doi.org/10.1002/jso.20780

    Article  CAS  PubMed  Google Scholar 

  4. Langenhoff BS, Krabbe PF, Wobbes T et al (2001) Quality of life as an outcome measure in surgical oncology. Br J Surg 88(5):643–652. https://doi.org/10.1046/j.1365-2168.2001.01755.x

    Article  CAS  PubMed  Google Scholar 

  5. Davies AR, Sandhu H, Pillai A et al (2014) Surgical resection strategy and the influence of radicality on outcomes in oesophageal cancer. Br J Surg 101(5):511–517. https://doi.org/10.1002/bjs.9456

    Article  CAS  PubMed  Google Scholar 

  6. Barreto JC (2010) Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol 16(30):3804. https://doi.org/10.3748/wjg.v16.i30.3804

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kauppila JH, Johar A, Gossage JA et al (2018) Health-related quality of life after open transhiatal and transthoracic oesophagectomy for cancer. Br J Surg 105(3):230–236. https://doi.org/10.1002/bjs.10745

    Article  CAS  PubMed  Google Scholar 

  8. de Boer AGEM, van Lanschot JJB, van Sandick JW et al (2004) Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol 22(20):4202–4208. https://doi.org/10.1200/JCO.2004.11.102

    Article  PubMed  Google Scholar 

  9. Hulscher JBF, van Sandick JW, de Boer AGEM et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669. https://doi.org/10.1056/NEJMoa022343

    Article  PubMed  Google Scholar 

  10. Rindani R, Martin CJ, Cox MR (1999) Transhiatal versus Ivor-lewis oesophagectomy: is there a difference? Aust N Z J Surg 69(3):187–194

    Article  CAS  PubMed  Google Scholar 

  11. Hulscher JB, Tijssen JG, Obertop H et al (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72(1):306–313

    Article  CAS  PubMed  Google Scholar 

  12. Raymond DP, Friedberg JS, Chen W (2017) Complications of esophageal resection. https://www.uptodate.com/contents/complications-of-esophageal-resection#H551085259. Zugegriffen: 26. Apr. 2018

    Google Scholar 

  13. Williams VA, Watson TJ, Zhovtis S et al (2008) Endoscopic and symptomatic assessment of anastomotic strictures following esophagectomy and cervical esophagogastrostomy. Surg Endosc 22(6):1470–1476. https://doi.org/10.1007/s00464-007-9653-6

    Article  CAS  PubMed  Google Scholar 

  14. Hirano M, Tanaka S, Fujita M et al (1993) Vocal cord paralysis caused by esophageal cancer surgery. Ann Otol Rhinol Laryngol 102(3 Pt 1):182–185. https://doi.org/10.1177/000348949310200304

    Article  CAS  PubMed  Google Scholar 

  15. Fujita H, Kakegawa T, Yamana H et al (1995) Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Ann Surg 222(5):654–662. https://doi.org/10.1097/00000658-199511000-00008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Shimizu H, Shiozaki A, Fujiwara H et al (2017) Short- and long-term progress of recurrent laryngeal nerve paralysis after subtotal esophagectomy. Anticancer Res 37(4):2019–2023. https://doi.org/10.21873/anticanres.11546

    Article  PubMed  Google Scholar 

  17. Donington JS (2006) Functional conduit disorders after esophagectomy. Thorac Surg Clin 16(1):53–62. https://doi.org/10.1016/j.thorsurg.2006.01.002

    Article  PubMed  Google Scholar 

  18. Aly A, Jamieson GG (2004) Reflux after oesophagectomy. Br J Surg 91(2):137–141. https://doi.org/10.1002/bjs.4508

    Article  CAS  PubMed  Google Scholar 

  19. Davis JL, Ripley RT (2017) Postgastrectomy syndromes and nutritional considerations following gastric surgery. Surg Clin North Am 97(2):277–293. https://doi.org/10.1016/j.suc.2016.11.005

    Article  PubMed  Google Scholar 

  20. Keim V, Klar E, Poll M et al (2009) Postoperative care following pancreatic surgery: surveillance and treatment. Dtsch Arztebl Int 106(48):789–794. https://doi.org/10.3238/arztebl.2009.0789

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nitsche U, Siveke J, Friess H et al (2015) Spätkomplikationen nach Pankreaseingriffen: Pankreasinsuffizienz, Malabsorptionssyndrom, pankreopriver Diabetes mellitus, Pseudozysten (Delayed complications after pancreatic surgery: Pancreatic insufficiency, malabsorption syndrome, pancreoprivic diabetes mellitus and pseudocysts). Chirurg 86(6): 533–539. doi: 10.1007/s00104-015-0006-z

    Article  CAS  PubMed  Google Scholar 

  22. Kang JS, Jang J‑Y, Kang MJ et al (2016) Endocrine function impairment after distal pancreatectomy: incidence and related factors. World J Surg 40(2):440–446. https://doi.org/10.1007/s00268-015-3228-9

    Article  PubMed  Google Scholar 

  23. Kim K‑J, Jeong C‑Y, Jeong S‑H et al (2011) Pancreatic diabetes after distal pancreatectomy: incidence rate and risk factors. Korean J Hepatobiliary Pancreat Surg 15(2):123–127. https://doi.org/10.14701/kjhbps.2011.15.2.123

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Grant CS, van Heerden JA (1979) Anastomotic ulceration following subtotal and total pancreatectomy. Ann Surg 190(1):1–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Warner BW (2009) Short- and long-term complications of colectomy. J Pediatr Gastroenterol Nutr 48(Suppl 2):S72–S74. https://doi.org/10.1097/MPG.0b013e3181a15a80

    Article  PubMed  Google Scholar 

  26. Morks AN, Ploeg RJ, Sijbrand Hofker H et al (2013) Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis 15(5):e271–e275. https://doi.org/10.1111/codi.12167

    Article  CAS  PubMed  Google Scholar 

  27. Lindgren R, Hallböök O, Rutegård J et al (2011) What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54(1):41–47. https://doi.org/10.1007/DCR.0b013e3181fd2948

    Article  PubMed  Google Scholar 

  28. Polese L, Vecchiato M, Frigo AC et al (2012) Risk factors for colorectal anastomotic stenoses and their impact on quality of life: What are the lessons to learn? Colorectal Dis 14(3):e124–e128. https://doi.org/10.1111/j.1463-1318.2011.02819.x

    Article  CAS  PubMed  Google Scholar 

  29. Suchan KL, Muldner A, Manegold BC (2003) Endoscopic treatment of postoperative colorectal anastomotic strictures. Surg Endosc 17(7):1110–1113. https://doi.org/10.1007/s00464-002-8926-3

    Article  CAS  PubMed  Google Scholar 

  30. Schlegel RD, Dehni N, Parc R et al (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44(10):1464–1468

    Article  CAS  PubMed  Google Scholar 

  31. Abbas MA (2008) Sphincter preservation for distal rectal cancer: how low is too low? Am J Clin Oncol 31(2):195–198. https://doi.org/10.1097/COC.0b013e3180ca7c72

    Article  PubMed  Google Scholar 

  32. Grumann MM, Noack EM, Hoffmann IA et al (2001) Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 233(2):149–156

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Colorectal Dis 12(10):958–964. https://doi.org/10.1111/j.1463-1318.2009.02006.x

    Article  CAS  PubMed  Google Scholar 

  34. Londono-Schimmer EE, Leong AP, Phillips RK (1994) Life table analysis of stomal complications following colostomy. Dis Colon Rectum 37(9):916–920

    Article  CAS  PubMed  Google Scholar 

  35. Tekkis PP, Cornish JA, Remzi FH et al (2009) Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum 52(1):46–54. https://doi.org/10.1007/DCR.0b013e318197551e

    Article  CAS  PubMed  Google Scholar 

  36. Lange MM, Maas CP, Marijnen CAM et al (2008) Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 95(8):1020–1028. https://doi.org/10.1002/bjs.6126

    Article  CAS  PubMed  Google Scholar 

  37. Ho VP, Lee Y, Stein SL et al (2011) Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum 54(1):113–125. https://doi.org/10.1007/DCR.0b013e3181fb7b82

    Article  PubMed  Google Scholar 

  38. Grade M, Beham AW, Schüler P et al (2016) Pelvic intraoperative neuromonitoring during robotic-assisted low anterior resection for rectal cancer. J Robot Surg 10(2):157–160. https://doi.org/10.1007/s11701-015-0556-6

    Article  PubMed  Google Scholar 

  39. Kauff DW, Lang H, Kneist W (2017) Risk factor analysis for newly developed urogenital dysfunction after total mesorectal excision and impact of pelvic Intraoperative neuromonitoring—a prospective 2‑year follow-up study. J Gastrointest Surg 21(6):1038–1047. https://doi.org/10.1007/s11605-017-3409-y

    Article  PubMed  Google Scholar 

  40. Kneist W, Kauff DW, Rubenwolf P et al (2013) Intraoperative monitoring of bladder and internal anal sphincter innervation: a predictor of erectile function following low anterior rectal resection for rectal cancer? Results of a prospective clinical study. Dig Surg 30(4–6):459–465. https://doi.org/10.1159/000357349

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein- Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    Maria Zerche, Jens Sperling & Michael Ghadimi

Authors
  1. Maria Zerche
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens Sperling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Ghadimi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Zerche.

Ethics declarations

Interessenkonflikt

M. Zerche, J. Sperling und M. Ghadimi geben an, dass kein Interessenkonflikt besteht.

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zerche, M., Sperling, J. & Ghadimi, M. Spätfolgen nach onkologischer Chirurgie. Onkologe 24, 761–771 (2018). https://doi.org/10.1007/s00761-018-0403-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-018-0403-2

Schlüsselwörter

Keywords

Search

Navigation