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Grenzen der Chirurgie in der Uroonkologie

Limits of surgery in uro-oncology

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Zusammenfassung

Die Grenzen der Tumorchirurgie in der Uroonkologie werden bestimmt durch eine Balance zwischen dem chirurgisch Machbaren und dem onkologisch Notwendigen. Die Grenzen der Tumorchirurgie in der Uroonkologie stellen keine feststehenden Dogmen dar, sondern verschieben sich auf der Grundlage aktueller wissenschaftlicher Erkenntnisse, verbesserter bildgebender Diagnostik, optimierter Operationstechniken und postoperativer Versorgungsstrukturen zunehmend. Bestimmt werden die Grenzen der Tumorchirurgie durch patientenspezifische Faktoren, die biologische Aggressivität des jeweiligen Tumors, die handwerkliche Expertise des Operateurs sowie eine adäquate, standardisierte prä-, peri- und postoperative Versorgung des Patienten. In Abhängigkeit der jeweiligen Karzinome aus dem oberen und unteren Urogenitaltrakt müssen die spezifischen Besonderheiten bezüglich der Prognose unter Berücksichtigung aktueller molekulare Erkenntnisse sowie moderner multimodaler Therapiekonzepte bekannt sein, um die für den Patienten gemeinsam mit dem Patienten richtigen Entscheidungen treffen zu können. In dem vorliegenden Artikel werden zunächst allgemeine, die Grenzen der urologischen Tumorchirurgie potentiell beeinflussende Faktoren durch den Patienten, den Tumor und den Chirurgen diskutiert, bevor beispielhaft die Grenzen der Tumorchirurgie für die organbegrenzten sowie die fortgeschrittenen Malignome der Niere, der Prostata und des Hodens anhand ausgewählter klinischer Szenarien besprochen werden.

Abstract

The limits of cancer surgery in uro-oncology are characterized by a carefully weighed risk of surgical feasibility and oncological necessity. The limits of uro-oncological cancer surgery do not represent fixed dogmas but ideally these more or less cognitive boundaries move based on new scientific findings, improved imaging modalities, optimized surgical techniques and perioperative care. The limits of cancer surgery are defined by patient-specific parameters, the biological aggressiveness of the tumor itself, the skills and expertise of the surgeon, and adequate perioperative care of the patient. Dependent on the origin of the cancers of the upper and lower urogenital tract, the specific particularities of each individual cancer in terms of prognosis need to be known, taking into consideration the newest molecular insights and modern multimodality treatment regimes. Only the consideration of the above mentioned basics will allow the best decision to be made with the patient concerning the optimal individual treatment. The current article highlights general parameters of the patient, tumor and surgeon which might define the limits of cancer surgery in uro-oncology. In addition, specific clinical scenarios are discussed with regard to surgery limits in cancer of the kidney, the prostate and the testis.

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  1. Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    A. Heidenreich

  2. Klinik für Urologie, Medizinische Universität Wien, Wien, Österreich

    A. Heidenreich

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Heidenreich, A. Grenzen der Chirurgie in der Uroonkologie. Urologe 57, 1058–1068 (2018). https://doi.org/10.1007/s00120-018-0735-y

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