AGO-Empfehlungen zur operativen Therapie des Mammakarzinoms: Update 2022

Zusammenfassung

Die Empfehlungen der AGO Kommission Mamma zur operativen Therapie des Mammakarzinoms wurden zuletzt im März 2022 aktualisiert (www.ago-online.de). Da die operative Therapie einen von mehreren Teilschritten bei der Behandlung des Mammakarzinoms darstellt, ist eine umfangreiche diagnostische und onkologische Expertise eines Brustoperateurs und gute interdisziplinäre Zusammenarbeit mit den diagnostischen Radiologen von großer Bedeutung. Die wichtigsten Änderungen betreffen die Lokalisationstechniken, die Resektionsränder, das axilläre Management im neoadjuvanten Setting und die Bewertung der Netze in der rekonstruktiven Chirurgie. Aufgrund von Metanaanalysen randomisierter Studien wurde der Empfehlungsgrad der intraoperativen Mammasonografie zur Lokalisation nicht palpabler Befunde auf „++“ erhöht. Somit wird die Technik als gleichwertig zur Drahtlokalisation angesehen, vorausgesetzt, es handelt sich um eine sonografisch gut darstellbare Läsion, der Operateur verfügt über umfangreiche Kenntnisse in der Mammasonografie und hat Zugang zu einem geeigneten Ultraschallgerät während der Operation. Beim invasiven Mammakarzinom wird das Erreichen von negativen Resektionsrändern („no tumor on ink“) angestrebt, unabhängig davon, ob eine extensive intraduktale Komponente vorliegt oder nicht. Onkoplastische Operationen können durch die Vielzahl der existierenden Techniken in ausgewählten Fällen auch eine Mastektomie ersetzen und sind im Vergleich zu einer regulären Segmentresektion hinsichtlich der onkologischen Sicherheit bei vergleichbaren Komplikationsraten gleichwertig. Patientinnen mit cN0-Status, die eine neoadjuvante Chemotherapie erhalten, wird eine Sentinel-Node-Exzision nach Abschluss der Chemotherapie empfohlen. Bei initial suspekten Lymphknoten wird die minimalinvasive Sicherung empfohlen. Nach der neoadjuvanten Chemotherapie stehen Patientinnen mit initial 1 – 3 suspekten Lymphknoten und gutem Ansprechen (ycN0) die Targeted axillary Dissection und die Axilladissektion als gleichwertige Optionen zur Verfügung.

Schlüsselwörter

Mammakarzinom - Brustchirurgie - chirurgische Therapie - Leitlinien - neoadjuvante Chemotherapie

Publikationsverlauf

Eingereicht: 18. Juni 2022

Angenommen: 18. Juli 2022

Artikel online veröffentlicht:
30. September 2022

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