Chirurgie der Lungenmetastasen

 

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Zusammenfassung

Eine Vielzahl von malignen Erkrankungen kann im natürlichen Verlauf zum Auftreten von Lungenmetastasen führen. Wesentliche Entscheidungskriterien für die chirurgische Resektion sind gegeben, wenn der Primärtumor kontrolliert erscheint, keine extrathorakale Metastasierung nachweisbar ist und systemische Behandlungsalternativen fehlen. Die chirurgischen Verfahren beruhen auf dem Prinzip der vollständigen Entfernung aller sicht- bzw. tastbaren Herdsetzungen in der Lunge unter Berücksichtigung der Organfunktion, vorteilhaft kombiniert mit einer systematischen ipsilateralen Lymphknotendissektion. Das Ziel der chirurgisch kompletten Resektion unter Berücksichtigung eines maximalen gewebserhaltenden und damit die Organfunktion präservierenden Vorgehens bestimmen die Operationsstrategie. Das Behandlungskonzept sollte stets im interdisziplinären Konzept unter Einschluss des internistischen Onkologen festgelegt werden. Bei kritischer Patientenselektion unter Berücksichtigung tumorspezifischer Prognoseparameter lassen sich 5-Jahres-Überlebensraten von bis zu 60 % erzielen.

Abstract

In the natural history of cancer many types of extrathoracic tumors metastasize to the lungs. The most significant factor in selecting patients for surgery include control of the primary tumor, absence of extrathoracic metastases, lack of effective system therapy, and sufficient cardiopulmonary reserve for the planned operation. The principle of surgery for lung metastases is the removal of all lesions in the lungs that are either visible or detectable by palpation. This may be combined with complete dissection of all ipsilateral lymph nodes. Pulmonary metastasectomy should be performed by the most limited parenchymal resection permitting a curative resection. The decision to proceed with surgical resection of lung metastases should be a multidisciplinary one, together with the medical oncologist. A selected group of patients with metastases limited to the lungs may benefit from pulmonary metastasectomy with a 5-year survival rate up to 60 %.

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Dr. med. J. Pfannschmidt

Thoraxklinik am Universitätsklinikum

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Email: joachim.pfannschmidt@thoraxklinik-heidelberg.de