Therapiestrategien beim synchron metastasierten Kolonkarzinom
Tóm tắt
Das Kolonkarzinom ist aggressiv und zeigt eine hohe Neigung zur Metastasierung. Die therapeutische Entscheidungsfindung bei potenziell resektablen Metastasen oder asymptomatischem Primarius und irresektablen Fernmetastasen ist schwierig. Die aktuelle Evidenzlage zur Therapie des synchron metastasierten Kolonkarzinoms wird zusammengefasst. Resektable Leber‑, Lungen- oder peritoneale Metastasen sollten primär reseziert werden. Potenziell resektable Metastasen sollten mittels Chemotherapie-Doublette sowie ggf. Antikörpern behandelt und bei sekundär-resektablem Befund reseziert werden (Konversionstherapie). Bei irresektablen Metastasen und palliativer Chemotherapie ist ein Überlebensvorteil durch die Primärtumorresektion (PTR) unwahrscheinlich. Jeder Patient mit metastasiertem Kolonkarzinom sollte zur Einholung einer Zweitmeinung an einem Zentrum für Metastasenchirurgie vorgestellt werden. Bei Vorliegen bestimmter Risikofaktoren für Primärtumor-assoziierte Komplikationen unter Chemotherapie kann eine PTR angezeigt sein.
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