Zusammenfassung
Eine Vielzahl von malignen Erkrankungen kann im natürlichen Verlauf zum Auftreten
von Lungenmetastasen führen. Wesentliche Entscheidungskriterien für die chirurgische
Resektion sind gegeben, wenn der Primärtumor kontrolliert erscheint, keine extrathorakale
Metastasierung nachweisbar ist und systemische Behandlungsalternativen fehlen. Die
chirurgischen Verfahren beruhen auf dem Prinzip der vollständigen Entfernung aller
sicht- bzw. tastbaren Herdsetzungen in der Lunge unter Berücksichtigung der Organfunktion,
vorteilhaft kombiniert mit einer systematischen ipsilateralen Lymphknotendissektion.
Das Ziel der chirurgisch kompletten Resektion unter Berücksichtigung eines maximalen
gewebserhaltenden und damit die Organfunktion präservierenden Vorgehens bestimmen
die Operationsstrategie. Das Behandlungskonzept sollte stets im interdisziplinären
Konzept unter Einschluss des internistischen Onkologen festgelegt werden. Bei kritischer
Patientenselektion unter Berücksichtigung tumorspezifischer Prognoseparameter lassen
sich 5-Jahres-Überlebensraten von bis zu 60 % erzielen.
Abstract
In the natural history of cancer many types of extrathoracic tumors metastasize to
the lungs. The most significant factor in selecting patients for surgery include control
of the primary tumor, absence of extrathoracic metastases, lack of effective system
therapy, and sufficient cardiopulmonary reserve for the planned operation. The principle
of surgery for lung metastases is the removal of all lesions in the lungs that are
either visible or detectable by palpation. This may be combined with complete dissection
of all ipsilateral lymph nodes. Pulmonary metastasectomy should be performed by the
most limited parenchymal resection permitting a curative resection. The decision to
proceed with surgical resection of lung metastases should be a multidisciplinary one,
together with the medical oncologist. A selected group of patients with metastases
limited to the lungs may benefit from pulmonary metastasectomy with a 5-year survival
rate up to 60 %.
Schlüsselwörter
Lungenmetastasen - Chirurgie - Prognosefaktoren
Key words
Pulmonary metastases - surgery - prognostic factor
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Dr. med. J. Pfannschmidt
Thoraxklinik am Universitätsklinikum
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D-69126 Heidelberg
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