Zusammenfassung
In den USA und Westeuropa werden zur Versorgung sowohl von Narben- als auch Leistenhernien
Kunststoffnetze implantiert. Die Kurzzeit- und Langzeitergebnisse von Kunststoffnetzen
bezüglich der Komplikationsrate, Rezidivfreiheit und des Patientenkomforts sind überzeugend.
Ein potenzielles Karzinogeneserisiko von Biomaterialien wird von einigen Arbeitsgruppen
diskutiert. Es existieren experimentelle Ansätze bei denen in der Tat durch die Implantation
unterschiedlichster Fremdmaterialien (z. B. Kunststoffe und Metalle) bei Mäusen und
Ratten Weichgewebssarkome induziert werden können. Beim Menschen allerdings ist trotz
millionenfacher Verwendung von Kunststoffnetzen in der Hernienchirurgie bis zum heutigen
Tag kein einziger Kasus beschrieben. Der Nachweis von Proliferationsmarkern, von Apoptose
sowie der Modulation von Heat-Shock Proteinen bei Netzimplantaten erscheint nicht
ausreichend um das Karzinogeneserisiko im Zusammenhang mit Kunsstoffnetzen einschätzen
zu können.
Zusammenfassend liegen bis zum heutigen Tage keine Beweise vor, die ein reales Karzinogenesepotenzial
von Biomaterialien beim Menschen nahelegen. Aufgrund der derzeitigen Datenlage kann
somit nach unserer Einschätzung die Implantation von Biomaterialien in der Hernienchirurgie
beim Erwachsenen weiterhin propagiert werden.
Abstract
The implantation of meshes to correct inguinal as well as incisional hernias is widely
used in the U.S.A. and Western Europe. The short and long term results of meshes are
convincing concerning complications, recurrence rate and patient's comfort. On the
other hand side some scientific groups discuss the possibility of malignant tumor
development due to implanted meshes. In fact, experimental models exist which demonstrate
that soft tissue sarcomas can be induced in mice and rats by implanting artificial
materials such as synthetics or metal. Beside millions of hernia repairs using meshes
worldwide no patient has been reported with a soft tissue tumor until today. The analyses
of molecular markers of proliferation, of apoptosis as well as the modulation of heat
shock proteins seem not to prove the carcinogenic potential of meshes.
In conclusion, there are no data so far indicating a real risk for humans to develop
malignant tumors due to implanted meshes. Therefore we further propagate the implantation
of meshes in hernia repair in adult patients.
Schlüsselwörter
Hernie - Kunststoffnetz - Karzinogenese - Mausmodell - Sarkom
Key words
Hernia - mesh - carcinogenesis - mouse model - sarcoma
Literatur
- 1
Amici C, Rossi A, Santoro M G.
Aspirin enhances thermotolerance in human erythroleukemic cells: an effect associated
with the modulation of the heat shock response.
Cancer Res.
1995;
55
4452-4457
- 2
Amid P K, Shulman A G, Lichtenstein I L.
Critical scrutiny of the open “tension-free” hernioplasty.
Am J Surg.
1993;
165
369-371
- 3
Bischoff F, Bryson G.
Carcinogenesis through solid state surfaces. Prog.
Exp Tumor Res.
1964;
5
85-133
- 4
Brand K G, Bouen L C, Brand I.
Foreign-body tumorgenesis by vinyl chloride vinyl acetate copolymer: no evidence for
chemical carcinogenesis.
J Natl Cancer Inst.
1975;
54
1259-1262
- 5
Brand K G, Buoen L C, Brand I.
Foreign-body tumors of mice: strain and sex differences in latency and incidence.
J Natl Cancer Inst.
1977;
58
1443-1447
- 6
Brand K G, Buoen L C, Brand I.
Foreign-body tumorigenesis induced by glass and smooth and rough plastic: comparaive
study of pre-neoplastic events.
J Natl Cancer Inst.
1975;
55
319-322
- 7
Brand K G, Buoen L C, Brand I.
Multiphasic incidence of foreign body induced sarcomas.
Cancer Res.
1976;
36
3681-3683
- 8
Brand K G, Buoen L C, Johnson K H, Brand I.
Etiological factors, stages and the role of foreign-body tumorigenesis: a review.
Cancer Res.
1975;
35
279-286
- 9
Brand K G, Brand I.
Risk assessment of carcinogenesis at implantation sites.
Plastic Reconstructive Surg.
1980;
66
591-594
- 10
Brinton L A, Lubin J H, Burich M C, Colton T, Hoover R N.
Mortality among augmentation mammoplasty patients.
Epidemiology..
2001;
12
321-326
- 11 Cairns J. Cancer: Science and Society. WH Freeman, San Francisco 1978
- 12
Friis S, McLaughlin J K, Mellemkjaer L, Kjoller K H, Blot W J, Boice J D, Fraumeni J F,
Olsen J H.
Breast implants and cancer risk in Denmark.
Int J Cancer.
1997;
71
956-958
- 13
Hay J M, Boudet M J, Fingerhut A, Poucher J, Hennet H, Habib E, Veyrieres M, Flamant Y.
Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter
controlled trial in 1 578 patients.
Ann Surg.
1995;
222
719-727
- 14
Hetzer F H, Hotz T, Steinke W, Schumpf R, Decurtins M, Largadier F.
Gold Standard for inguinal hernia repair: shouldice or Lichtenstein?.
Hernia.
1999;
3
117-120
- 15
Hoffmann R, Frick T. et al .
Bassini or Shouldice?.
Helv Chir Acta.
1991;
58
207-212
- 16
Iovanna J L.
Redifferentiation and apoptosis of pancreatic cells during acute pancreatitis.
Int J Pancreatol.
1996;
20
77-84
- 17
Kiang J G, Tsokos G C.
Heat shock protein 70 kDa: molecular biology, biochemistry, and physiology.
Pharmacol Ther.
1998;
80
183-201
- 18
Kirkpatrick C J, Alves A, Kohler H, Kriegsmann J, Bittinger F, Otto M, Williams D F,
Eloy R.
Biomaterial-induced sarcoma: A novel model to study preneoplastic change.
Am J Pathol.
2000;
156
1455-1467
- 19
Klosterhalfen B, Klinge U, Hermanns B, Schumpelick V.
Pathology of traditional surgical nets for hernia repair after long-term implantation
in humans.
Chirurg.
2000;
71
43-51
- 20
Koot V C, Peeters P H, Granath F, Grobbee D E, Nyren O.
Total and cause specific mortality among Swedish women with cosmetic breast implants:
prospective study.
BMJ.
2003;
326
527-528
- 21
Nakamura T, Shimizu Y, Okumura N, Matsui T, Hyon S H, Shimamoto T.
Tumorigencity of poly-L-lactide (PLLA) plates compared with medical-grade polyethylene.
J Biomed Mater Res.
1994;
28
17-25
- 22
Nakamura T, Ueda H, Tsuda T, Li Y H, Kiyotani T, Inoue M, Matsumoto K, Sekine T, Yu L,
Hyon S H, Shimizu Y.
Long-term implantation test and tumorigenicity of polyvinyl alcohol hydrogel plates.
J Biomed Mater Res.
2001;
56
289-296
- 23
O’Connell T X, Fee H J, Golding A J.
Sarcoma associated with dacron prosthetic material: case report and review of the
literature.
Thorac Cardiovasc Surg.
1976;
72
94-96
- 24 Ott G. Fremdkörpersarkome. Springer, Berlin, Heidelberg, New York 1970
- 25
Pukkala E, Kulmala I, Hovi S L, Hemminki E, Keskimaki I, Lipworth L, Boice J D, McLaughlin J K.
Causes of Death Among Finnish Women with Cosmetic Breast Implants, 1971-2001.
Ann Plast Surg..
2003;
51
339-342
- 26 Rutkow I M. Epidemiologic, economic, and sociologic aspects of hernia surgery in
the United States in the 1990's. In: Rutkow IM (ed). The Surgical Clinics of North
America, Groin Hernia Surgery. WB Saunders 1998; 941-951
- 27
Schafer C, Williams J A.
Stress kinases and heat shock proteins in the pancreas: possible roles in normal function
and disease.
J Gastroenterol.
2000;
35
1-9
- 28
Shulman A G, Amid P K, Lichtenstein I L.
The “plug” repair of 1 402 recurrent inguinal hernias. 20-year experience.
Arch Surg.
1990;
125
265-267
- 29
Suvannavejh G C, Dal Canto M C, Matis L A, Miller S DJ.
Fas-mediated apoptosis in clinical remissions of relapsing experimental autoimmune
encephalomyelitis.
Clin Invest.
2000;
105
223-231
- 30
Weinberg D S, Maini B S.
Primary sarcoma of the aorta associated with a vascular prosthesis: a case report.
Cancer.
1980;
46
398-402
- 31
Weiss W M, Riles T S, Gouge T H, Mizrachi H H.
Angiosarcoma at the site of a Dacron vascular prosthesis: a case report and literature
review.
J Vasc Surg.
1991;
14
87-91
- 32
Yanagisawa N, Mikami T, Koike M, Okayasu I.
Enhanced cell kinetics, p53 accumulation and high p21WAF1 expression in chronic cholecystitis:
comparison with background mucosa of gallbladder carcinomas.
Histopathology.
2000;
36
54-61
Prof. Dr. med. Heinz Becker
Klinik und Poliklinik für Allgemeinchirurgie
Universitätsklinikum Göttingen
Robert Koch-Str. 40
37075 Göttingen
