Zentralblatt für Chirurgie
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Retroperitoneal soft-tissue sarcomas (RSTS) represent a rare and heterogeneous class of diseases for which the clinical management is still largely non-standardised. Based on a selective review of recent publications, it was the purpose of the present review article to summarize the current concepts of disease classification, diagnostics and surgical as well as multimodal therapy for these tumors. ⋯ The clinical management of RSTS is complex and can only partly be considered as evidence-based. Due to the required level of experience in the treatment of these tumor lesions and the involvement of several subspecialties, pre-therapeutic planning, treatment and follow-up should be limited to high-volume surgical centres. In order to achieve microscopically negative resection margins, multivisceral resections are a valuable option after thorough consideration of the risks and benefits. Adjuvant radiotherapy needs to be decided upon on an individual basis, taking into account patient- and tumor-specific factors as well as resection status.
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About 160 palliative care units with 1228 beds or 15 beds / 1 million inhabitants were available in German hospitals in the year 2008. Demand analyses consider 35 beds / 1 million inhabitants as necessary. Whether the additional demand could be reduced by a greater use of home- and hospice-based end-of-life care is discussed. ⋯ However, data suggest that prior experience in palliative care alters the selection of treatment recommendations by surgeons with respect to more supportive or aggressive interventions in patients with advanced cancer. Ethical decision-making regarding therapy and counselling of patients at the end of life and discussing the prognosis with patients and their families require education in palliative medicine. A core curriculum to teach palliative care for surgical residents therefore has been presented.