Grenzbereiche der viszeralonkologischen Chirurgie

Continuous improvements in technical possibilities, digital innovations, and advances in multimodal treatment concepts, as well as improvements in the perioperative care of patients and further centralization, are shifting the boundaries of oncologic surgery. This has led to an expansion of indications for patients with oligometastatic disease. Metastasis surgery has long been established for patients with colorectal cancer and is currently also being tested in clinical trials for patients with pancreatic or gastric and esophageal cancer. Selected patients with limited peritoneal carcinomatosis can now also benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). For nonresectable colorectal liver metastases, organ transplantation is currently being evaluated in numerous clinical trials. A new challenge is how to deal with the presence of complete clinical remission when performing total neoadjuvant therapies, with the requirement for organ and functional preservation. Improved perioperative management can also reduce the morbidity of complex oncologic interventions and, finally, oncologic surgery can also play a role in palliative situations with very good and individualized indications.