Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Häufige urologisch-sexualmedizinische Themen in der Praxis sind das Thema des MMW-Webinars am 5. Juni von 17.30 bis 19 Uhr. Konkret geht es um die Frage, wann bei Harnwegsinfektionen auf Antibiotika verzichtet werden kann, und um ein Update zur Therapie von Libido- und Potenzstörungen des Mannes. Der dritte Vortrag behandelt sexuell übertragbare Krankheiten. Stellen Sie Ihre Fragen an die Experten und sammeln Sie 2 CME-Punkte. Jetzt gleich anmelden!
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 1/2020

30.08.2019 | Melanoma

The Landmark Series: Regional Therapy of Recurrent Cutaneous Melanoma

verfasst von: Georgia M. Beasley, MD, Jonathan S. Zager, MD, John F. Thompson, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

In-transit melanoma represents a distinct disease pattern in which melanoma recurs as dermal or subcutaneous nodules between the primary melanoma site and the draining regional lymph node basin. The disease pattern is often not amenable to complete surgical resection. Since the 1950s, regional therapies have been explored for the treatment of this disease entity, with the goal of maximizing delivery of the therapeutic agent to the tumor while minimizing systemic toxicity. We reviewed landmark studies describing and evaluating regional chemotherapy and intralesional therapies for patients with in-transit melanoma metastases.
Literatur
1.
Pawlik TM, Ross MI, Johnson MM, Schacherer CW, McClain DM, Mansfield PF, et al. Predictors and natural history of in-transit melanoma after sentinel lymphadenectomy. Ann Surg Oncol. 2005;12:587–596PubMed
2.
Pawlik TM, Ross MI, Thompson JF, Eggermont AM, Gershenwald JE. The risk of in-transit melanoma metastasis depends on tumor biology and not the surgical approach to regional lymph nodes. J Clin Oncol. 2005;23:4588–4590PubMed
3.
Read RL, Haydu L, Saw RP, et al. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol. 2015;22:475–481PubMed
4.
Balch CM, Soong S, Ross MI, Urist MM, Karakousis CP, Temple WJ, et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol. 2000;7:87–97PubMed
5.
Creech O Jr Krementz ET, Ryan RF, Winblad JN. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958;148:616–632.PubMedPubMedCentral
6.
Creech O Jr, Krementz ET, Ryan RF, Reemtsma K, Winblad JN. Experiences with isolation-perfusion technics in the treatment of cancer. Ann Surg. 1959;149:627–640PubMedPubMedCentral
7.
Creech O Jr, Ryan RF, Krementz ET. Treatment of melanoma by isolation-perfusion technique. J Am Med Assoc. 1959;169:339–343PubMed
8.
Klopp CT, Alford TC, Bateman J, Berry GN, Winship T. Fractionated intra-arterial cancer; chemotherapy with methyl bis amine hydrochloride; a preliminary report. Ann Surg. 1950;132:811–832.PubMedPubMedCentral
9.
Krementz ET, Ryan RF: Chemotherapy of melanoma of the extremities by perfusion: fourteen years clinical experience. Ann Surg. 1972;175:900–917PubMedPubMedCentral
10.
Koops HS, Vaglini M, Suciu S, Kroon BB, Thompson JF, Gohl J, et al. Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. European Organization for Research and Treatment of Cancer Malignant Melanoma Cooperative Group Protocol 18832, the World Health Organization Melanoma Program Trial 15, and the North American Perfusion Group Southwest Oncology Group-8593. J Clin Oncol. 1998;16:2906–2912PubMed
11.
Lienard D, Eggermont AM, Kroon BB, Schraffordt Koops H, Lejeune FJ: Isolated limb perfusion in primary and recurrent melanoma: indications and results. Semin Surg Oncol. 1998;14:202–209PubMed
12.
Vrouenraets BC, Nieweg OE, Kroon BB. Thirty-five years of isolated limb perfusion for melanoma: indications and results. Br J Surg. 1996;83:1319-28PubMed
13.
Taber SW, Polk HC Jr. Mortality, major amputation rates, and leukopenia after isolated limb perfusion with phenylalanine mustard for the treatment of melanoma. Ann Surg Oncol. 1997;4:440–445PubMed
14.
Fraker DL. Hyperthermic regional perfusion for melanoma and sarcoma of the limbs. Curr Probl Surg. 1999;36:841–907PubMed
15.
Bates DA, Mackillop WJ. The effect of hyperthermia in combination with melphalan on drug-sensitive and drug-resistant CHO cells in vitro. Br J Cancer. 1990;62:183–188PubMedPubMedCentral
16.
Laskowitz DT, Elion GB, Dewhirst MW, Griffith OW, Savina PM, Blum MR, et al. Hyperthermia-induced enhancement of melphalan activity against a melphalan-resistant human rhabdomyosarcoma xenograft. Radiat Res. 1992;129:218–223PubMed
17.
Aloia TA, Grubbs E, Onaitis M, Mosca PJ, Cheng TY, Seigler H, et al. Predictors of outcome after hyperthermic isolated limb perfusion: role of tumor response. Arch Surg. 2005;140:1115–1120PubMed
18.
Barbour AP, Thomas J, Suffolk J, Beller E, Smithers BM. Isolated limb infusion for malignant melanoma: predictors of response and outcome. Ann Surg Oncol. 2009;16:3463–3472PubMed
19.
Nieweg OE, Kroon BB. Isolated limb perfusion with melphalan for melanoma. J Surg Oncol. 2014;109:332–337PubMed
20.
Moreno-Ramirez D, de la Cruz-Merino L, Ferrandiz L, Villegas-Portero R, Nieto-Garcia A. Isolated limb perfusion for malignant melanoma: systematic review on effectiveness and safety. Oncologist. 2010;15:416–427PubMedPubMedCentral
21.
Alexander HR Jr, Fraker DL, Bartlett DL, Libutti SK, Steinberg SM, Soriano P, et al. Analysis of factors influencing outcome in patients with in-transit malignant melanoma undergoing isolated limb perfusion using modern treatment parameters. J Clin Oncol. 2010;28:114–118PubMed
22.
Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, for members of the American Joint Committee on Cancer Melanoma Expert P, the International Melanoma Database and Discovery Platform, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67:472–492PubMedPubMedCentral
23.
Chin-Lenn L, Temple-Oberle C, McKinnon JG. Isolated limb infusion: efficacy, toxicity and an evolution in the management of in-transit melanoma. Plast Surg (Oakv). 2015;23:25–30PubMedPubMedCentral
24.
Wieberdink J, Benckhuysen C, Braat RP, van Slooten EA, Olthuis GA. Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions. Eur J Cancer Clin Oncol. 1982;18:905–910PubMed
25.
Raymond AK, Beasley GM, Broadwater G, Augustine CK, Padussis JC, Turley R, et al. Current trends in regional therapy for melanoma: lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution. J Am Coll Surg. 2011;213:306–316PubMedPubMedCentral
26.
Reintgen DS, Cruse CW, Wells KE, Saba HI, Slingluff CL Jr. Isolated limb perfusion for recurrent melanoma of the extremity. Ann Plast Surg. 1992;28:50–54PubMed
27.
Papa MZ, Klein E, Karni T, Koller M, Davidson B, Azizi E, et al. Regional hyperthermic perfusion with cisplatin following surgery for malignant melanoma of the extremities. Am J Surg. 1996;171:416–420PubMed
28.
Lienard D, Eggermont AM, Schraffordt Koops H, Kroon BB, Rosenkaimer F, Autier P,et al. Isolated perfusion of the limb with high-dose tumour necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and melphalan for melanoma stage III. Results of a multi-centre pilot study. Melanoma Res. 1994;4 Suppl 1:21–26PubMed
29.
Cornett WR, McCall LM, Petersen RP, Ross MI, Briele HA, Noyes RD, et al. Randomized multicenter trial of hyperthermic isolated limb perfusion with melphalan alone compared with melphalan plus tumor necrosis factor: American College of Surgeons Oncology Group Trial Z0020. J Clin Oncol. 2006;24:4196–4201PubMed
30.
Hoekstra HJ, Veerman K, van Ginkel RJ. Isolated limb perfusion for in-transit melanoma metastases: melphalan or TNF-melphalan perfusion? J Surg Oncol. 2014;109:338–347PubMed
31.
Olofsson R, Mattsson J, Lindner P. Long-term follow-up of 163 consecutive patients treated with isolated limb perfusion for in-transit metastases of malignant melanoma. Int J Hyperthermia. 2013;29:551–557PubMed
32.
Thompson JF, Waugh RC, Saw RPM, Kam PCA. Isolated limb infusion with melphalan for recurrent limb melanoma: a simple alternative to isolated limb perfusion. Regional Cancer Treat. 1994;7:188–192
33.
Lindner P, Doubrovsky A, Kam PC, Thompson JF. Prognostic factors after isolated limb infusion with cytotoxic agents for melanoma. Ann Surg Oncol. 2002;9:127–136PubMed
34.
Beasley GM, Petersen RP, Yoo J, McMahon N, Aloia T, Petros W, et al. Isolated limb infusion for in-transit malignant melanoma of the extremity: a well-tolerated but less effective alternative to hyperthermic isolated limb perfusion. Ann Surg Oncol. 2008;15:2195–205PubMed
35.
O’Donoghue C, Perez MC, Mullinax JE, Hardman D, Sileno S, Naqvi SMH, et al. Isolated limb infusion: a single-center experience with over 200 infusions. Ann Surg Oncol. 2017;24:3842–3849PubMed
36.
Miura JT, Kroon HM, Beasley GM, Mullen D, Farrow NE, Mosca PJ, et al. Long-term oncologic outcomes after isolated limb infusion for locoregionally metastatic melanoma: an international multicenter analysis. Ann Surg Oncol. 2019;26(8):2486–2494PubMed
37.
Dossett LA, Ben-Shabat I, Olofsson Bagge R, Zager JS. Clinical response and regional toxicity following isolated limb infusion compared with isolated limb perfusion for in-transit melanoma. Ann Surg Oncol. 2016;23:2330–2335PubMed
38.
Kroon HM, Thompson JF. Isolated limb infusion and isolated limb perfusion for melanoma: can the outcomes of these procedures be compared? Ann Surg Oncol. 2019;26:8–9PubMed
39.
Ribas A, Wolchok JD. Cancer immunotherapy using checkpoint blockade. Science. 2018;359:1350–1355PubMed
40.
Long GV, Stroyakovskiy D, Gogas H, Levchenko E, de Braud F, Larkin J, et al. Combined BRAF and MEK inhibition versus BRAF inhibition alone in melanoma. N Engl J Med. 2014;371:1877–1888PubMed
41.
Franklin C, Livingstone E, Roesch A, Schilling B, Schadendorf D. Immunotherapy in melanoma: recent advances and future directions. Eur J Surg Oncol. 2017;43:604–611PubMed
42.
Byers BA, Temple-Oberle CF, Hurdle V, McKinnon JG. Treatment of in-transit melanoma with intra-lesional interleukin-2: a systematic review. J Surg Oncol. 2014;110:770–775PubMed
43.
Krone B, Kolmel KF, Henz BM, Grange JM. Protection against melanoma by vaccination with Bacille Calmette-Guerin (BCG) and/or vaccinia: an epidemiology-based hypothesis on the nature of a melanoma risk factor and its immunological control. Eur J Cancer. 2005;41:104–117PubMed
44.
Danielli R, Patuzzo R, Di Giacomo AM, Gallino G, Maurichi A, Di Florio A, et al. Intralesional administration of L19-IL2/L19-TNF in stage III or stage IVM1a melanoma patients: results of a phase II study. Cancer Immunol Immunother. 2015;64:999–1009PubMed
45.
Sato-Kaneko F, Yao S, Ahmadi A, Zhang SS, Hosoya T, Kaneda MM, et al. Combination immunotherapy with TLR agonists and checkpoint inhibitors suppresses head and neck cancer. JCI Insight. 2017;2(18):e93397PubMedCentral
46.
Kolmel KF, Grange JM, Krone B, Mastrangelo G, Rossi CR, Henz BM, et al. Prior immunisation of patients with malignant melanoma with vaccinia or BCG is associated with better survival. An European Organization for Research and Treatment of Cancer cohort study on 542 patients. Eur J Cancer. 2005;41:118–125PubMed
47.
Ross MI. Intralesional therapy with PV-10 (Rose Bengal) for in-transit melanoma. J Surg Oncol. 2014;109:314–319PubMed
48.
Zamarin D, Holmgaard RB, Subudhi SK, Park JS, Mansour M, Palese P, et al. Localized oncolytic virotherapy overcomes systemic tumor resistance to immune checkpoint blockade immunotherapy. Sci Transl Med. 2014;6:226ra32PubMedPubMedCentral
49.
Brown MC, Holl EK, Boczkowski D, Dobrikova E, Mosaheb M, Chandramohan V, et al. Cancer immunotherapy with recombinant poliovirus induces IFN-dominant activation of dendritic cells and tumor antigen-specific CTLs. Sci Transl Med. 2017;9(408):eaan4220PubMedPubMedCentral
50.
Kuryk L, Moller AW, Jaderberg M. Combination of immunogenic oncolytic adenovirus ONCOS-102 with anti-PD-1 pembrolizumab exhibits synergistic antitumor effect in humanized A2058 melanoma huNOG mouse model. Oncoimmunology. 2019;8:e1532763PubMed
51.
Shi SW, Li B, Dong Y, Ge Y, Qu X, Lu LG, et al. In vitro and clinical studies of gene therapy with recombinant human adenovirus-p53 injection for malignant melanoma. Hum Gene Ther Clin Dev. 2019;30(1):7–18PubMed
52.
Kaufman HL, Kohlhapp FJ, Zloza A. Oncolytic viruses: a new class of immunotherapy drugs. Nat Rev Drug Discov. 2015;14:642–662PubMed
53.
Senzer NN, Kaufman HL, Amatruda T, Nemunaitis M, Reid T, Daniels G, et al. Phase II clinical trial of a granulocyte-macrophage colony-stimulating factor-encoding, second-generation oncolytic herpesvirus in patients with unresectable metastatic melanoma. J Clin Oncol. 2009;27:5763–5771PubMed
54.
Andtbacka RH, Kaufman HL, Collichio F, Amatruda T, Senzer N, Chesney J, et al. Talimogene laherparepvec improves durable response rate in patients with advanced melanoma. J Clin Oncol. 2015;33:2780–2788
55.
Veverka KK, Jakub JW, Baum CL. Responses to topical diphenylcyclopropenone as an adjunct treatment for in-transit melanoma: a tertiary referral center experience. Dermatol Surg. 2018;44:1501–1508PubMed
56.
Gibbons IL, Sonagli M, Bertolli E, Macedo MP, Pinto CAL, Duprat Neto JP. Diphencyprone as a therapeutic option in cutaneous metastasis of melanoma. A single-institution experience. An Bras Dermatol. 2018;93:299–301PubMed
57.
Read T, Webber S, Tan J, Wagels M, Schaider H, Soyer HP, et al. Diphenylcyclopropenone for the treatment of cutaneous in-transit melanoma metastases: results of a prospective, non-randomized, single-centre study. J Eur Acad Dermatol Venereol. 2017;31:2030–2037PubMed
58.
Damian DL, Saw RP, Thompson JF. Topical immunotherapy with diphencyprone for in transit and cutaneously metastatic melanoma. J Surg Oncol. 2014;109:308–313PubMed
59.
Flaherty KT, Robert C, Hersey P, Nathan P, Garbe C, Milhem M, Metric Study Group. et al.; Improved survival with MEK inhibition in BRAF-mutated melanoma. N Engl J Med. 2012;367:107–114PubMed
60.
Hodi FS, Chesney J, Pavlick AC, Robert C, Grossmann KF, McDermott DF, et al. Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial. Lancet Oncol. 2016;17:1558–1568PubMedPubMedCentral
61.
Jaques DP, Coit DG, Brennan MF. Major amputation for advanced malignant melanoma. Surg Gynecol Obstet. 1989;169:1–6PubMed
62.
Ebskov LB. Major amputation for malignant melanoma: an epidemiological study. J Surg Oncol. 1993;52:89–91PubMed
63.
Harrington KJ, Andtbacka RH, Collichio F, Downey G, Chen L, Szabo Z, et al. Efficacy and safety of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor in patients with stage IIIB/C and IVM1a melanoma: subanalysis of the Phase III OPTiM trial. Onco Targets Ther. 2016;9:7081–7093PubMedPubMedCentral
64.
Jiang BS, Speicher PJ, Thomas S, Mosca PJ, Abernethy AP, Tyler DS. Quality of life after isolated limb infusion for in-transit melanoma of the extremity. Ann Surg Oncol. 2015;22:1694–700PubMed
65.
Weitman ES, Perez M, Thompson JF, Andtbacka RHI, Dalton J, Martin ML, et al. Quality of life patient-reported outcomes for locally advanced cutaneous melanoma. Melanoma Res. 2018;28:134–142PubMed
66.
Ariyan CE, Brady MS, Siegelbaum RH, Hu J, Bello DM, Rand J, et al. Robust antitumor responses result from local chemotherapy and CTLA-4 blockade. Cancer Immunol Res. 2018;6(2):189–200PubMedPubMedCentral
67.
Ribas A, Dummer R, Puzanov I, VanderWalde A, Andtbacka RHI, Michielin O, et al. Oncolytic virotherapy promotes intratumoral T cell infiltration and improves anti-PD-1 immunotherapy. Cell. 2017;170:1109–1119.e10
68.
Puzanov I, Milhem MM, Minor D, Hamid O, Li A, Chen L, et al. Talimogene laherparepvec in combination with ipilimumab in previously untreated, unresectable stage IIIB-IV melanoma. J Clin Oncol. 2016;34:2619–2626PubMed
69.
Chesney J, Puzanov I, Collichio F, Singh P, Milhem MM, Glaspy J, et al. Randomized, open-label phase II study evaluating the efficacy and safety of talimogene laherparepvec in combination with ipilimumab versus ipilimumab alone in patients with advanced, unresectable melanoma. J Clin Oncol. 2018;36:1658–1667PubMed
Metadaten
Titel
The Landmark Series: Regional Therapy of Recurrent Cutaneous Melanoma
verfasst von
Georgia M. Beasley, MD
Jonathan S. Zager, MD
John F. Thompson, MD
Publikationsdatum
30.08.2019
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 1/2020
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07760-7

Weitere Artikel der Ausgabe 1/2020

Annals of Surgical Oncology 1/2020 Zur Ausgabe

Peritoneal Surface Malignancy

Effect of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Quality of Life in Patients with Peritoneal Mesothelioma

Melanoma

The Landmark Series: Randomized Trials Examining Surgical Margins for Cutaneous Melanoma

Peritoneal Surface Malignancy

Utilization and Treatment Patterns of Cytoreduction Surgery and Intraperitoneal Chemotherapy in the United States

Peritoneal Surface Malignancy

Desmoplastic Small Round Cell Tumor: Long-Term Complications After Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy

Peritoneal Surface Malignancy

Efficacy of Postoperative Chemotherapy After Resection that Leaves No Macroscopically Visible Disease of Gastric Cancer with Positive Peritoneal Lavage Cytology (CY1) or Localized Peritoneum Metastasis (P1a): A Multicenter Retrospective Study

Melanoma

The Sunbelt Melanoma Trial

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Traumatologische Notfälle Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Internistische Arzneimitteltherapie Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.
Bildnachweise