Zusammenfassung
Die operative Therapie des Mammakarzinoms hat sich entscheidend weiterentwickelt, vor allem geprägt durch reduzierte lokale Radikalität. Mehrstufige Therapiekonzepte ermöglichen, die Operation nicht zwangsläufig am Beginn der Therapie durchführen zu müssen. Die radikale Mastektomie nach Halsted war lange der operative Standard beim Mammakarzinom. Mittlerweile werden bis zu 70–80 % aller Patientinnen brusterhaltend operiert. Obwohl diese Therapie seit Jahrzehnten präferiert wird, gibt es nach wie vor keinen endgültigen Konsens über adäquate Resektionsränder. Die Strategie der axillären Lymphknotenentfernung hat sich ebenfalls gewandelt. Wurde bis vor wenigen Jahren grundsätzlich noch eine komplette Axilladissektion gefordert, so empfiehlt die Datenlage bei brusterhaltender Therapie heute, den Verzicht selbst bei positivem Sentinel-node-Status. Neoadjuvante Therapiekonzepte gestatten ggf. eine weitere Steigerung der Brusterhaltung. Für andere Fälle sind alle rekonstruktiven Möglichkeiten zu prüfen, wenn eine Mastektomie indiziert ist.
Abstract
Operative therapy of breast cancer has undergone decisive further development especially in the reduction of local radicality. Multistage therapy concepts mean that operations must not necessarily be carried out at the initiation of therapy. Radical mastectomy according to Halsted was the operative standard for breast cancer for a long time but nowadays, up to 70–80 % of patients receive breast-conserving surgery. Although this therapy has been preferred for decades, there is no final consensus on adequate resection margins. The strategy of axillary lymph node resection has also changed. Only a few years ago a complete axillary dissection was basically deemed necessary but nowadays, the available data on breast-conserving therapy do not recommend this, even in the case of positive sentinel node status. Neoadjuvant therapy concepts allow when necessary a further increase in breast-conservation. In other cases all reconstructive possibilities should be checked if mastectomy is indicated.
Abbreviations
- ALD:
-
axilläre Lymphdissektion
- ALNE:
-
axilläre Lymphonodektomie
- BET:
-
brusterhaltende Therapie
- DCIS:
-
duktales Carcinoma in situ
- DIEP:
-
deep inferior epigastric artery perforator
- FNR:
-
Falsch-negativ-Rate
- I-GAP:
-
inferior gluteal artery perforator
- MAK:
-
Mammillen-Areola-Komplex
- ME:
-
Mastektomie
- MRM:
-
modifizierte radikale Mastektomie
- NSM:
-
Nipple-sparing-Mastektomie
- PST:
-
primär systemische Therapie
- SNB:
-
Sentinel-node-Biopsie
- SSM:
-
Skin-sparing-Mastektomie
- TRAM:
-
transverse rectus abdominis myocutaneus
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Interessenkonflikt. V. Fink, L. Schwentner und W. Janni geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Fink, V., Schwentner, L. & Janni, W. Update operative Therapie des Mammakarzinoms. Gynäkologe 47, 667–676 (2014). https://doi.org/10.1007/s00129-014-3446-5
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DOI: https://doi.org/10.1007/s00129-014-3446-5