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Aktuelle Aspekte zur operativen Therapie des primären Ovarialkarzinoms

Was ist Standard? Wann Neoadjuvanz?

Current aspects of surgical treatment of primary ovarian cancer

What is standard? When neoadjuvant treatment?

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Zusammenfassung

Durch das zunächst asymptomatische und später unspezifische Beschwerdebild wird das Ovarialkarzinom im Großteil der Fälle im fortgeschrittenen Stadium diagnostiziert. Ein wichtiger prognostischer Faktor ist das Erreichen der makroskopischen Tumorfreiheit im Rahmen der Primäroperation. Dies geht mit einem medianen Überlebensvorteil von > 5 Jahren einher. Die systematische LNE (Lymphonodektomie) hat beim fortgeschrittenen Ovarialkarzinom mit unauffälligen Lymphknoten nach aktueller Datenlage keinen Einfluss auf das Gesamtüberleben und sollte daher ab dem Stadium IIB bei in der Bildgebung und palpatorisch unauffälligen Lymphknoten auch nicht mehr durchgeführt werden. Im frühen Krankheitsstadium ist die Operation im Sinne eines Stagings primär von diagnostischer Bedeutung. In diesen Fällen bleibt die systematische LNE ein wichtiger Bestandteil der Operation, um den Nodalstatus und damit das FIGO(Fédération Internationale de Gynécologie et dʼObstétrique)-Stadium korrekt festlegen zu können. Auch das perioperative Management hat Auswirkungen auf das Gesamtüberleben und führte zuletzt zu einer Reduktion von frühen Ereignissen im QS(Qualitätssicherung)-Programm der AGO(Arbeitsgemeinschaft Gynäkologische Onkologie)-Ovar. Internationale Studien zum ERAS(Enhanced Recovery After Surgery)-Protokoll konnten zeigen, dass über einen multimodalen Ansatz mit schnellerer postoperativer Erholung verbunden mit einer kürzeren Liegedauer letztlich auch Kosten für das Gesundheitssystem reduziert werden können. Der international kontrovers diskutierten Frage zum optimalen Operationszeitpunkt widmet sich die TRUST-Studie erneut und auf höchstem operativem Niveau. Ergebnisse werden für 2024 erwartet.

Abstract

As ovarian cancer is initially asymptomatic and does not typically present with specific symptoms, it often remains undiscovered until advanced stages of disease. Achieving macroscopic complete resection in primary debulking surgery is one of the most important prognostic factors and is associated with a median survival benefit of >5 years. According to current data, systematic lymphadenectomy (LNE) in advanced ovarian cancer with inconspicuous lymph nodes has no influence on overall survival. It should therefore no longer be carried out above stage IIB in cases of inconspicuous lymph nodes by imaging and palpation. In early stages of disease surgery is primarily of diagnostic importance in the sense of a staging. In these cases, systematic LNE remains an important component of the surgical procedure in order to be able to correctly determine the nodal status and therefore the Fédération Internationale de Gynécologie et dʼObstétrique (FIGO) stage. The perioperative management also has consequences for the overall survival and ultimately led to a reduction of early events in a recent analysis of the quality assurance (QA) program of the working group on gynecology and oncology (AGO-Ovar). International studies on the enhanced recovery after surgery (ERAS) protocol could show that using a multimodal approach with faster postoperative recovery associated with a shorter hospital stay, the costs for the healthcare system could also ultimately be reduced. The optimal timing of surgery in advanced ovarian cancer has internationally been the subject of debate for many years and has recently been readdressed by the TRUST trial at the highest surgical level. The results are expected for 2024.

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  1. Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Charlotte v. Bülow, Katharina Prieske, Anna Jäger &  Barbara Schmalfeldt

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  1. Charlotte v. Bülow
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  2. Katharina Prieske
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Correspondence to Barbara Schmalfeldt.

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C. v. Bülow, K. Prieske, A. Jäger und B. Schmalfeldt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Barbara Schmalfeldt, Hamburg

Tanja Fehm, Düsseldorf

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v. Bülow, C., Prieske, K., Jäger, A. et al. Aktuelle Aspekte zur operativen Therapie des primären Ovarialkarzinoms. Gynäkologe 55, 155–163 (2022). https://doi.org/10.1007/s00129-022-04905-w

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