Radikale Nephrektomie und Nierenteilentfernung

Zusammenfassung

Das Nierenzellkarzinom ist der zweithäufigste bzw. dritthäufigste urologische maligne Tumor der Frau bzw. des Mannes mit einem Erkrankungsgipfel in der 7. Lebensdekade. Früh erkannt ist es gut heilbar, sofern der Tumor nicht metastasiert ist. Im Gegensatz zu früher ist bei lokal begrenzten Nierenzellkarzinomen die lokale Therapie (Teil-Entfernung/topische Energieapplikation wie Radio-Frequenz-Ablation oder Kryoablation) die leitliniengerechte operative Therapie, wobei je nach Expertise des Operateurs die minimalinvasive (laparoskopisch/roboterassistiert) oder offene Operation ihre Berechtigung haben. Die verschiedenen Leitlinien setzen hier unterschiedliche Akzente. Bei der individuellen Therapieentscheidung müssen aber insbesondere Alter und Komorbiditäten in die Überlegung einbezogen werden. Dies kann dazu führen, dass auch bei lokal begrenzten Tumoren aufgrund der geringen perioperativen Morbidität eine (minimalinvasive) radikale Nephrektomie an Stelle einer Teil-Nephrektomie zu empfehlen ist oder aber eine aktive Überwachungsstrategie die richtige Behandlungsoption darstellt, ohne die Lebenserwartung des Karzinomträgers zu kompromittieren. Höhergradige Tumoren hingegen sollen – vorausgesetzt es sind keine Metastasen nachweisbar – Indikation zur Nephrektomie sein, auch wenn z. B. Tumorthromben bis in den Vorhof reichen. Mögliche Komplikationen eines operativen Eingriffs sind in aller Regel selten und gut beherrschbar.

Abstract

Renal cell carcinoma is the 2nd most frequent urological malignancy in women and the third most frequent in men, with an age peak in the seventh decade of life. If detected early in a local non-metastatic stage, options for complete recovery are excellent. While two decades ago, even locally limited cancers of the kidney were cured by radical nephrectomy, treatment today mostly consists of local treatment for locally confined cancers. Guidelines today recommend local surgical excision (open or minimally-invasive) or – in selected cases – topical energy application (radio-frequency ablation, cryoablation). The surgeon’s expertise is most important in the selection of the appropriate kind of surgery and different guidelines have slightly different recommendations.

Treatment decisions should be made on an individual basis in due consideration of an individual’s age and co-morbidities. This may lead to the recommendation that, due to low perioperative morbidity, even localised carcinomas should be treated by (minimally-invasive) radical nephrectomy instead of nephron-sparing surgery and, in other cases, a non-interventional, active surveillance strategy may be pursued without compromising the patient’s life expectancy. For higher-grade renal cell carcinomas, there is usually an indication for radical nephrectomy, as long as no metastases are detected. This also applies to carcinomas with venous thrombi extending into the atrium of the heart. Complications in the treatment of renal carcinomas are usually rare and easily treatable in most cases.

Schlüsselwörter

Nierenkarzinom - Nephrektomie - Teilnephrektomie - Enukleation

Keywords

renal cancer - nephrectomy - partial nephrectomy - enucleation

Publication History

Article published online:
28 July 2020

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