Zusammenfassung
Verbesserte Operationstechniken und verfeinerte Diagnostik haben die chirurgische Indikationsstellung in der Resektion pulmonaler Metastasen erheblich erweitert (bilaterale/multiple Herde, Rezidive). Metastasen aller Primärtumore wurden mit kumulativen Überlebensraten zwischen 25-50 % reseziert.
Zur Qualitätssicherung werden eine gute Primärtumorkontrolle, fehlende extrapulmonale Metastasen, resektable Metastasen und ausreichende funktionelle Parenchymreserve vorausgesetzt. Die muskelschonende anterolaterale Thorakotomie erlaubt zudem durch die manuelle Palpation den Nachweis nicht vordiagnostizierter Herde. Bei einer kurativen Resektion darf die mediastinale Lymphknotendissektion nicht fehlen. Atypische und anatomische Resektionen sind heutzutage mit einer vertretbaren Komplikations- und Letalitätsrate assoziiert und sollten stets in Hinblick auf einen potenziell kurativen Ansatz abgewogen werden.
Als wichtigster prognostischer Faktor für das Langzeitüberleben hebt sich die Radikalität des Eingriffs hervor, gefolgt von Metastasenanzahl und -größe, tumorfreiem Intervall und Histologie des Primärtumors.
Die Ergebnisse der Lungenmetastasenchirurgie für die spezifischen Primärtumorarten werden anhand der Literaturrecherche kritisch beleuchtet.
Abstract
Improved Operation techniques and sophisticated diagnostics have increased resectability of pulmonary metastases (bilateral/multiple focuses, recurrence). Metastases of primary tumours irrespective of their origin have already been resected, with a cumulative survival rate of 25-50 %
For the quality assurance a good primary tumour control, missing extrapulmonal metastases, resectable metastases, and sufficient remaining pulmonary tissue are basic requirements. The less invasive anterolateral thoracotomy also permits the detection of lesions, previously not diagnosed by manual palpation. The mediastinal lymph node dissection is mandatory for a curative resection. Atypical and anatomical resections are nowadays associated with an acceptable morbidity/mortality and should therefore always be taken into consideration as different options for potentially curative therapies.
The curative resection followed by number and size of metastases, disease free interval and histological type of the primary tumour are the most important prognostic indicators for longterm survival.
Here we review the results of lung metastasectomy for certain primary tumours and critically discuss the findings an the background of the literature.
Schlüsselwörter
Lungenmetastasen - Lungenmetastasenchirurgie - Chirurgie - Prognosefaktoren - Überleben
Key words
Lung metastases - pulmonary metastases - lung metastasectomy - surgical resection - prognostic factors - survival
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PD Dr. med. R. A. Hatz
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