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Innovationen in der chirurgischen Behandlung solider Tumoren im Kindesalter

Innovations in surgical treatment of pediatric solid tumors

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Zusammenfassung

Die Gesamtüberlebensrate von Kindern mit einem soliden Tumor hat sich in den letzten Jahrzehnten dank des Fortschritts in allen an der Therapie beteiligten Fachdisziplinen deutlich verbessert. Eine Herausforderung sind weiterhin eine schlechte Prognose im fortgeschrittenen Erkrankungsstadium und die mit dem therapeutischen Vorgehen verbundene Morbidität. Innovationen in der chirurgischen Behandlung solider Tumoren können dazu beitragen, die Überlebensrate betroffener Kinder zu erhöhen und die therapiebedingte Morbidität zu verringern. Anhand von vier Beispielen wird die erfolgreiche Umsetzung von Innovationen unter diesen Aspekten aufgezeigt. (1) Die Tumornephrektomie war lange Zeit der Standardeingriff beim Wilms-Tumor (Nephroblastom). Modifikationen der Operationstechniken ermöglichen eine nierenerhaltende Tumorresektion und Verminderung der Langzeitfolgen nach Nephrektomie. (2) Die Therapie von Hochrisiko-Hepatoblastomen sieht in den aktuellen Protokollen der Internationalen Gesellschaft für Pädiatrische Onkologie (SIOP) eine Lebertransplantation vor. Mithilfe neuer Softwareprozessoren ist mittels virtueller Bildgebungsmethoden eine exaktere und individuelle Operationsplanung möglich, die eine organerhaltende Tumorresektion erlaubt und so eine Transplantation vermeidet. (3) Zur kurativen Therapie von Rhabdomyosarkomen sind zum Teil mutilierende Operationen notwendig. Durch eine Kombination von Chirurgie und Brachytherapie, können mutilierende Eingriffe im Urogenitalbereich vermieden werden. (4) Durch die CT-gesteuerte präoperative Markierung von Lungenmetastasen mittels „Coils“ werden diese der minimalinvasiven Resektion zugänglich. Dies spart in ausgesuchten Fällen eine Thorakotomie ein und verringert durch den kürzeren postoperativen Verlauf die Zeit bis zur anschließenden adjuvanten Therapie.

Abstract

The overall survival of children with solid tumors has shown a substantial increase in the past decades due to progress in all of the disciplines involved in the treatment. The poor prognosis for advanced stages of disease and the morbidity related to therapeutic procedures are still a challenge. Innovations in the surgical treatment of solid tumors can contribute to increase the survival rate of affected children and to decrease the treatment-related morbidity. Considering these aspects, the successful implementation of innovations is described based on four examples. (1) Tumor nephrectomy has long been the standard surgical procedure for Wilms tumor/nephroblastoma. Modifications of the surgical technique allow a nephron-sparing resection of the tumor and thereby reducing the long-term effects of nephrectomy. (2) According to the protocols of the International Society of Pediatric Oncology (SIOP) liver transplantation should be used for high-risk hepatoblastoma. Virtual imaging methods based on new software processors enable a more accurate and individual planning of the surgical procedure and an organ-saving extended tumor resection which avoids a transplantation. (3) Mutilating surgical procedures are sometimes necessary for a curative treatment of rhabdomyosarcoma. By combining surgery and brachytherapy mutilating surgical procedures for urogenital rhabdomyosarcomas can be avoided. (4) Pulmonary metastatic nodules can become accessible to minimally invasive resection if CT-guided marking by coil wire is preoperatively performed. In selected cases thoracotomy will be avoided and due to a shorter postoperative course, the time to the subsequent adjuvant chemotherapy will be reduced.

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Authors and Affiliations

  1. Abteilung für Kinderchirurgie und Kinderurologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    A. Schmidt, S. W. Warmann, C. Urla & J. Fuchs

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Correspondence to A. Schmidt.

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Interessenkonflikt

A. Schmidt, S. W. Warmann, C. Urla und J. Fuchs geben an, dass kein Interessenkonflikt besteht.

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

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Schmidt, A., Warmann, S.W., Urla, C. et al. Innovationen in der chirurgischen Behandlung solider Tumoren im Kindesalter. Chirurg 89, 205–211 (2018). https://doi.org/10.1007/s00104-017-0568-z

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  • DOI: https://doi.org/10.1007/s00104-017-0568-z

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