Die Rolle der Laserresektion in der Lungenmetastasenchirurgie

Zusammenfassung

Ziel der Studie Diese Übersichtsarbeit stellt die Laserenukleation im Zuge der Lungenmetastasenchirurgie dar und fasst die aktuelle Evidenz zusammen. Darüber hinaus wird die Laserchirurgie weiteren Resektionsverfahren gegenübergestellt.

Methodik Wir führten eine systematische Literaturrecherche zur Detektion von Fallserien und randomisierten Studien in der Medline und der Cochrane Library durch. Die eingeschlossenen Studien wurden einer qualitativen Analyse unterzogen.

Ergebnisse Die Laser-Metastasektomie ist ein sicheres Verfahren. Im Vergleich von Laserenukleation zu anderen Resektionstechniken ist die Datenlage hinsichtlich klinisch relevanter Endpunkte wie Hospitalisierungszeit, Einlagezeit der Thoraxdrainage und Langzeitüberleben heterogen und kontrovers. Die Laser-Metastasektomie führt sicher zu einer signifikanten Reduktion des Resektionsvolumens. Die Überlebensraten nach Laserresektion sind mit alternativen Resektionsmethoden vergleichbar.

Schlussfolgerung Als parenchymsparende Methode ermöglicht die Laserenukleation selbst bei multiplen Lungenmetastasen oder Patienten mit präoperativ eingeschränkter Lungenkapazität eine onkologisch radikale Resektion.

Abstract

Objectives This review presents laser resection as treatment option in pulmonary metastasectomy and summarizes the current evidence. Moreover, it includes the comparison of laser resection and common techniques used in lung metastasectomy.

Methods We performed a systematic literature research in Medline and the Cochrane library to detect case series and even randomized trials. All included studies underwent qualitative analysis.

Results Laser metastasectomy is a safe procedure. Data regarding relevant clinical end points as hospitalization, duration of chest tube drainage and long-term survival are heterogeneous and still controversial. Laser enucleation decreases the resection volume. Therefore, it leads to a significant reduction of parenchymal loss. Survival rates after laser metastasectomy are equal to the outcome after resection using other techniques.

Conclusions Laser resection is a parenchyma-sparing method. Hence, it offers radical metastasectomy even in case of multiple pulmonary lesions or impaired lung capacity.

• Literatur

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