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Zentralbl Chir 2006; 131(3): 223-229
DOI: 10.1055/s-2006-933466
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© Georg Thieme Verlag Stuttgart · New York

Retroperitoneale Sarkome: Diagnostik und Therapie

Retroperitoneal Sarcomas: Diagnostic and TherapyI. Gockel1 , K. Oberholzer2 , U. Gönner1 , S. Mantai1 , T. Junginger1
  • 1Klinik für Allgemein- und Abdominalchirurgie der Johannes-Gutenberg-Universität Mainz
  • 2Klinik für Radiologie der Johannes-Gutenberg-Universität Mainz
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Publication History

Publication Date:
31 May 2006 (online)

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Zusammenfassung

Hintergrund: Aufgrund des Fehlens fester anatomischer Kompartimente werden retroperitoneale Sarkome erst bei Vorliegen sehr großer Tumoren und Infiltration von Nachbarorganen diagnostiziert. Trotz Fortschritte der diagnostischen Möglichkeiten und chirurgischer Techniken kommt es auch nach kompletter Entfernung sehr häufig zu Lokalrezidiven mit ungünstiger Prognose. Ziel dieser Arbeit war die Analyse von Diagnostik, Therapie und Langzeitverlauf der retroperitonealen Sarkome im eigenen Krankengut über einen Zeitraum von 10 Jahren. Patienten und Methodik: Zwischen Januar 1995 und Januar 2005 wurde in unserer Klinik bei 379 Patienten ein operativer Eingriff wegen eines primären retroperitonealen Tumors durchgeführt. Unter den 67 (17,7 %) malignen Läsionen fand sich bei 35 Patienten ein Sarkom. Die vorliegende Untersuchung berücksichtigt den Langzeitverlauf der 21 Patienten mit primärem reseziertem retroperitonealem Sarkom, Rezidiveingriffe und Probelaparotomien ausgeschlossen. Ergebnisse: Das mediane Alter zum Zeitpunkt der Operation war 61 (25-86) Jahre, 57,1 % aller Patienten waren männlich. Die Dauer der Symptome betrug 3 (1-36) Monate. Eine pR0-Resektion konnte bei 20/21 Patienten erreicht werden. Unter den histopathologischen Tumortypen fanden sich am häufigsten Liposarkome (n = 10) und Leiomyosarkome (n = 6). Bei 12 von 21 Patienten kam es im Median 13,5 (5-42) Monate nach dem Ersteingriff zu einem Lokalrezidiv, bei 4 Patienten zu Fernmetastasen. Das Langzeitüberleben aller 21 Patienten mit primärem reseziertem retroperitonealem Sarkom betrug 24 (1-101) Monate. Dabei fanden sich günstigere Verläufe für Patienten mit Leiomyosarkom verglichen mit den Liposarkomen. Schlussfolgerung: Retroperitoneale Sarkome sind eine heterogene Entität und fanden sich im eigenen Krankengut bei 6,1 % aller primärer, operativ behandelter retroperitonealer Tumoren. Die Behandlungsstrategie ist komplex und abhängig von Stadium, Lokalisation und histologischen Charakteristika. Das Langzeitüberleben ist limitiert durch die hohe Rate an Lokalrezidiven.

Abstract

Background: Due to the fact that there are no distinct anatomical compartments, retroperitoneal sarcomas are moreover diagnosed with evidence of large tumors and infiltration of adjacent organs. In spite of improvement of the diagnostic facilities and surgical techniques, quite frequently local recurrences with unfavourable prognosis turn up even after complete removal. It was the aim of this study to analyze diagnosis, therapy and long-term prognosis in patients with retroperitoneal sarcomas over a period of 10 years. Patients and Methods: Between January 1995 and January 2005, 379 patients underwent surgery for a primary retroperitoneal tumor at our clinic. Among the 67 (17.1 %) malignant lesions, a sarcoma was found in 35 patients. The present study is focused on the long-term prognosis of those 21 patients with a primary resected retroperitoneal sarcoma, recurrent sarcomas and exploratory laparotomies excluded. Results: The median patient age at the time of surgery was 61 (25-86) years, 57.1 % were males. The duration of symptoms was 3 (1-36) months. A pR0-resection was achieved in 20/21 patients. Among the histopathological tumor types, liposarcomas (n = 10) and leiomyosarcomas (n = 6) were found most frequently. Local recurrence developed in 12 out of 21 patients at 13.5 (5-42) months after the first operation, and in 4 patients distant metastases were observed. The long-term survival of all 21 patients with primary resected retroperitoneal sarcoma was 24 (1-101) months. A more favourable prognosis was seen in patients with leiomyosarcoma as compared with liposarcoma. Conclusion: Retroperitoneal sarcomas are a heterogeneous entity, and they were found among our own patients in 6.1 % of all primary operatively treated retroperitoneal tumors. The strategy of treatment is complex and dependent on the stage, localization and histopathological characteristics. Long-term survival is limited as a result of the high rate of local recurrence.

Schlüsselwörter

retroperitoneale Sarkome - Differenzialdiagnostik - operatives Vorgehen - Langzeitverlauf

Key words

retroperitoneal sarcoma - differential diagnostic - operative procedure - long-term course

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Dr. med. Ines Gockel

Klinik für Allgemein- und Abdominalchirurgie · Johannes-Gutenberg-Universität

Langenbeckstr. 1

55101 Mainz

Phone: +49/(0)61 31/17 72 91

Fax: +49/(0)61 31/17 66 30

Email: gockel@ach.klinik.uni-mainz.de

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