Minimal-invasive Chirurgie und Tumorchirurgie – Palliative laparoskopische Techniken

Abstract

The oncological principles of radical tumor surgery are not proven to be successfully applied with today's laparoscopic techniques. The value of minimal invasive surgery has to be critically evaluated for the radical (R0) resection of malignant tumors. On the other hand, there is an indication for laparoscopic palliation in order to minimize the surgical trauma. Many publications have demonstrated the technical feasibility with acceptable morbidity and mortality and a decreased hospital stay. For different reasons (previous operations, assessment of resectability, use of interventional techniques etc.) laparoscopic palliation obviously is realized only in a small number of patients. The most frequently reported operation concerns the implantation of feeding catheters into the stomach or jejunum. If noncurability is proven preoperatively, the rate of laparoscopic palliations probably could be increased, if minimal access surgery could take a more definite place in the wide spectrum of therapeutical options. The operative techniques usually can be easily performed by the laparoscopically experienced surgeon today. However, benefit for the patients after palliative laparoscopic tumor resection has not yet been proven. The best condition for laparoscopic palliation is the discovery of the incurable situation during diagnostic laparoscopy. Laparoscopic palliation should follow directly within the same session.

Helium pneumoperitoneum reduces tumor recurrence after curative laparoscopic liver resection in rats in a tumor-bearing small animal model

“…Numerous authors are skeptical of the feasibility of laparoscopic tumor resection due to the higher risk of spreading malignant cells, small safety margins, and undiscovered secondary neoplasms [18,19,23], often explicitly discussing the problem of possible port-site metastases [11,15,17,18]. In this study, our goal was to evaluate the long-term outcome of laparoscopic partial liver resection due to a malignant tumor in relation to the gas used for the creation of pneumoperitoneum (CO 2 , helium, and air).…”

“…The more extensive use of helium in experimental and, occasionally, clinical laparoscopy has led to further investigation of this gas. Various studies have shown significantly lower rates of tumor growth in a helium environment than in room air or CO 2 surrounding [5-7, 15, 16, 20, 21], which has been discovered both in vitro and in vivo [6,15,16,19]. The mechanisms of this reduction of tumor growth remain unclear; however, it has been suggested that an enhancement of malignant growth and spread under the influence of CO 2 is more responsible than a tumor growth-suppressing effect of helium.…”

Traumareduktion durch minimal invasive Chirurgie

“…Dennoch wurden bis heute nur kleine Serien über die Palliation des nicht resektablen stenosierenden Magenkarzinoms mittel MIC publiziert [40,45].Auch bei Magenausgangsstenose durch einen lokal fortgeschrittenen Pankreaskopftumor ist eine Gastroenterostomie mit Braun-…”

Vorgehen beim primär metastasierten Rektumkarzinom in palliativer Intention

“…Das geringe Operationstrauma ermöglicht die Beschleunigung der Rekonvaleszenz und damit die Verkürzung des postoperativen Krankenhausaufenthaltes [27,28] …”