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Thoraxchirurgie im Alter

Thoracic surgery in the elderly

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Zusammenfassung

In naher Zukunft werden bereits über 40% der an Bronchialkarzinom Erkrankten über 75 Jahre alt sein. Älteren Patienten sollte jedoch ein Eingriff am Thorax nicht allein aufgrund des Alters verweigert werden. Es ist gezeigt worden, dass ältere Patienten (über 70 Jahre) als auch über 80-Jährige eine Lob- oder Pneumonektomie tolerieren. Die meisten Patienten mit Bronchialkarzinom befinden sich in höherem Alter und haben als Folge langjährigen Tabakkonsums oftmals noch eine begleitende obstruktive Lungenerkrankung und atherosklerotisch bedingte kardiovaskuläre Risiken. Voraussetzung für die Indikationsstellung zu einem thorakalen Eingriff ist eine zuverlässige präoperative Stadienzuordnung und funktionelle Abklärung — unter besonderer Berücksichtigung des kardiopulmonalen Status — durch ein interdisziplinäres Team, sodass unter Einbeziehung des ASA-Index das Operationsrisiko und die Langzeitprognose adäquat dargestellt werden können. Da lediglich im Frühstadium des nichtkleinzelligen Bronchialkarzinoms nach kurativer Resektion eine 5-Jahres-Überlebensrate von über 50% erwartet werden kann, kommt der Patientenselektion eine hohe Verantwortung zu.

Abstract

In the near future, over 40% of patients with lung cancer will be over 70 years old at the time their disease is diagnosed. Age per se, however, should not lead to the denial of a potentially curative surgical intervention. It has been shown that older patients (over 70 years), as well as patients over 80 years of age, may tolerate a lobectomy or even a pneumonectomy quite well. Most patients with lung cancer are present or former smokers and have underlying pulmonary problems, especially chronic obstructive lung disease. They are at high risk of both morbidity and mortality from surgery due to significant cardiovascular disease. The indications for surgical intervention should be based on reliable preoperative tumor staging and pulmonary assessment by an experienced interdisciplinary panel of physicians, taking into consideration the individual cardiopulmonary status of the patient. This assessment, combined with the American Society of Anesthesiologists risk classification and the overall clinical assessment by the surgeon, will provide the best available evidence for carefully weighing the benefits and risks of an operation. The responsibility for this assessment must be viewed—in the case of early stage lung cancer—in relation to the relative lack of alternative treatments for surgical intervention with comparable 5-year survival rates (>50%).

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  1. Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum Heidelberg

    H. Dienemann & H. Hoffmann

  2. Abteilung Innere Medizin — Pneumologie, Thoraxklinik Heidelberg

    F. Herth

  3. Chirurgische Abteilung, Thoraxklinik am Universitätsklinikum, Amalienstraße 5, 69126, Heidelberg

    H. Dienemann

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Dienemann, H., Hoffmann, H. & Herth, F. Thoraxchirurgie im Alter. Chirurg 76, 126–130 (2005). https://doi.org/10.1007/s00104-004-0981-y

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