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Pneumonektomie

Eine Alternative zur Manschettenresektion beim Lungenkarzinom?

Pneumonectomy

An alternative to sleeve resection in lung cancer patients?

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Zusammenfassung

Mehr als die Hälfte aller Lungenkarzinome sind im Oberlappen lokalisiert. Die anatomische Nähe zum Lungenhilus birgt das Risiko der Tumorinfiltration von zentralen Strukturen des Bronchial- und Gefäßbaumes. Bei der Resektion der zentralen Tumoren konkurrieren die Pneumonektomie und Manschettenresektion am Bronchial- und Gefäßbaum der Lunge. Die vorliegende Übersichtsarbeit befasst sich mit der Frage, ob die Pneumonektomie eine Alternative zur Manschettenresektion beim Lungenkarzinom darstellt. Bei gleichwertiger onkologischer Radikalität für beide Operationsverfahren sind die Lokalrezidivraten niedriger nach Manschettenresektionen. Eine primäre Pneumonektomie bringt auch im fortgeschrittenen Lymphknotenstatus keinen Vorteil. Erweiterte Lymphknotendissektionen sind für die Manschettenchirurgie keine Kontraindikation. Mortalitäts- und Morbiditätsraten sind signifikant niedriger bei der Sleeve-Resektion. Manschettenresektionen sind mit einem besseren Überleben und einer besseren Lebensqualität vergesellschaftet, selbst im höheren Lebensalter.

Abstract

Lung cancer is localized in the upper lobes in more than half of the cases. The risk of tumor infiltration of centrally located structures, such as bronchi and vessels are enhanced due to the anatomic topography. Pneumonectomy competes with sleeve resection for the surgical resection of centrally located tumors. The present review deals with the question if pneumonectomy should be considered as an alternative to sleeve resection for the treatment of lung cancer. Primary pneumonectomy does not provide any advantage even in advanced nodal disease. Extended lymph node dissection is not a contraindication for sleeve resections. Local recurrence rate is lower after sleeve resections despite the same radicality for both surgical treatment options. Mortality and morbidity rates are significantly lower for sleeve resections. Sleeve resections are associated with prolonged survival and better quality of life even in elderly patients.

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Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Dr. Horst Schmidt Klinik, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland

    J. Schirren, M. Schirren, M. Passalacqua & S. Bölükbas

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  1. J. Schirren
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  2. M. Schirren
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  3. M. Passalacqua
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  4. S. Bölükbas
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Correspondence to J. Schirren.

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Schirren, J., Schirren, M., Passalacqua, M. et al. Pneumonektomie. Chirurg 84, 474–478 (2013). https://doi.org/10.1007/s00104-012-2430-7

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