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Chirurgie von pulmonalen Metastasen

Surgery of pulmonary metastases

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die Lungenmetastasenchirurgie bietet selbst im Stadium IV mit multiplem und beidseitigem Befall noch bei einer Reihe von malignen Primärtumoren die Möglichkeit der kurativen chirurgischen Behandlung. Da bei jedem dritten Patienten im Laufe der malignen Erkrankung Lungenmetastasen auftreten und bei jedem fünften von diesen Patienten isoliert die Lunge befallen ist, sollte die Indikation wesentlich häufiger im interdisziplinären Tumorboard diskutiert und gestellt werden. Außerdem sollte die Lunge bei malignen extrathorakalen Tumoren mit in die Ausbreitungsdiagnostik eingeschlossen werden und ebenfalls im Follow-up untersucht werden, um synchrone und metachrone Lungenmetastasen rechtzeitig im Therapieschema berücksichtigen zu können. Heutzutage stehen parenchymsparende Resektionstechniken zur Verfügung, wie z. B. die Lasertechnik, die es ermöglicht, komplikationsarm bis über 100 Metastasen pro Patient zu resezieren. Auch bei Patienten mit mehr als 20 und beidseitigen Metastasen sollte die Resektion diskutiert werden, da im Falle von vollständigen Resektionen 5-Jahresüberlebensraten von 20% erreicht werden können.

Abstract

The surgical resection of pulmonary metastases in diverse stage IV malignant tumors with multiple and bilateral lung involvement offers the possibility of curative therapy. Lung metastases occur in 30% of patients with malignant disease; in 20% the spread is limited to the lungs so that the indication for surgical resection should be discussed more often and recommended in interdisciplinary tumor boards. Furthermore to diagnose synchronous and metachronous spread to the lungs early, the lung should be included in follow-up examinations in patients with extrathoracic tumors. Nowadays lung parenchyma-sparing resection methods like the laser technique allow removal of more than 100 metastases per patient. In patients with over 20 metastases and bilateral involvement an operative resection should still be discussed because in these individuals when complete resection is achieved 5-year survival rates of 20% are being reported.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Es besteht eine rein familiäre Beziehung zur Firma Rolle & Rolle GmbH.

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  1. Klinik für Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig GmbH, Neucoswiger Str. 21, 01640, Coswig, Deutschland

    A. Rolle

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Rolle, A. Chirurgie von pulmonalen Metastasen. Pneumologe 7, 265–271 (2010). https://doi.org/10.1007/s10405-009-0359-4

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  • DOI: https://doi.org/10.1007/s10405-009-0359-4

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