Aktuelle Urol 2020; 51(03): 271-274
DOI: 10.1055/a-1140-5623
Übersicht

Operative Behandlung von Lungenmetastasen beim Nierenzellkarzinom

Surgical treatment of pulmonary metastases in metastatic renal cell carcinoma
Nils Gilbert
Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Urologie, Lübeck
› Author Affiliations

Zusammenfassung

Etwa 20 – 30 % der Patienten mit Nierenzellkarzinom leiden unter einer synchronen Metastasierung und weitere 20 – 30 % entwickeln metachrone Metastasen nach initialer Therapie. Die Therapie des metastasierten Nierenzellkarzinoms bleibt aufgrund der Implementierung von neuen systemischen Therapieoptionen sowie der Re-Evaluation bewährter Therapiekonzepte eine Herausforderung. Zudem besteht die Möglichkeit, Metastasen chirurgisch zu behandeln. Als Hauptmanifestationsort von Metastasen des Nierenzellkarzinoms kommt der Lunge hierbei eine besondere Rolle zu.

Die pulmonale Metastasektomie stellt ein etabliertes Therapiekonzept dar und ist als sicherer Eingriff anzusehen. Es existieren lediglich retrospektive Daten, die Hinweise auf die Sinnhaftigkeit der chirurgischen Therapie geben können. Hier scheint eine komplette Resektion eine günstige Prognose auf das Überleben der Patienten zu haben. Am ehesten können Patienten mit solitären Metastasen, ohne begleitende Lymphknotenmetastasen und einem langen krankheitsfreien Intervall nach initialer Tumorentfernung, profitieren. Auch erneute Metastasektomien bei weiteren Rezidiven sind möglich. Hier erscheinen Aussagen über den wirklichen Benefit zumindest anhand der Datenlage sehr schwierig und erfordern wie auch bei der primären Metastasektomie eine interdisziplinäre Therapieplanung und individuelle Therapieentscheide.

Abstract

Between 20 and 30 % of patients diagnosed with renal cell carcinoma suffer from metastatic disease by the time of diagnosis and a further 20 – 30 % develop metachronous metastases after initial treatment with curative intent. The therapeutic landscape of metastatic renal cell carcinoma seems be changing rapidly, with new systemic therapies or combination therapies available and established concepts being questioned because of long-awaited data.

Apart from systemic therapy, metastases can be treated by surgical resection. As the most common site of metastases in renal cell carcinoma, the lung plays an important role in local treatment.

Pulmonal metastasectomy is a safe procedure with low morbidity and mortality in the “right” patients. Nevertheless, there are only data from retrospective non-randomised comparative studies, which seem to show that complete metastasectomy is associated with a better prognosis and overall survival of patients. Patients with a solitary pulmonal metastasis, without involvement of hilar or mediastinal lymph nodes and a long disease-free interval after primary therapy, might benefit the most from surgery. Repeated metastasectomy can also be performed, although the data are sparse – which emphasises the need for interdisciplinary case discussions and individual therapy, as recommended in primary metastasectomy.



Publication History

Article published online:
23 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Literatur

  • 1 Thorstenson A, Harmenberg U, Lindblad P. et al. Cancer Characteristics and Current Treatments of Patients with Renal Cell Carcinoma in Sweden. Biomed Res Int 2015; 2015: 456040
  • 2 Flanigan RC. Debulking nephrectomy in metastatic renal cancer. Clin Cancer Res 2004; 10: 6335S-6341S
  • 3 Han JH, Lee SH, Ham WS. et al. Inherent characteristics of metachronous metastatic renal cell carcinoma in the era of targeted agents. Oncotarget 2017; 8: 78825-78837
  • 4 Brookman-May S, May M, Shariat SF. et al. Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project). Eur Urol 2013; 64: 472-477
  • 5 Thomford NR, Woolner LB, Clagett OT. The Surgical Treatment of Metastatic Tumors in the Lungs. J Thorac Cardiovasc Surg 1965; 49: 357-363
  • 6 Vogt-Moykopf I, Krysa S, Bulzebruck H. et al. Surgery for pulmonary metastases. The Heidelberg experience. Chest Surg Clin N Am 1994; 4: 85-112
  • 7 Kudelin N, Bolukbas S, Eberlein M. et al. Metastasectomy with standardized lymph node dissection for metastatic renal cell carcinoma: an 11-year single-center experience. Ann Thorac Surg 2013; 96: 265-270 ; discussion 270-261
  • 8 Pfannschmidt J. Chirurgische Therapieoptionen bei Lungenmetastasen. In: Schneider P, Kruschewski M, Buhr HJ. Hrsg. Thoraxchirurgie für den Allgemein- und Viszeralchirurgen. Berlin, Heidelberg: Springer; 2018: 157-166
  • 9 Dabestani S, Marconi L, Hofmann F. et al. Local treatments for metastases of renal cell carcinoma: a systematic review. Lancet Oncol 2014; 15: e549-561
  • 10 Piltz S, Meimarakis G, Wichmann MW. et al. Long-term results after pulmonary resection of renal cell carcinoma metastases. Ann Thorac Surg 2002; 73: 1082-1087
  • 11 Murthy SC, Kim K, Rice TW. et al. Can we predict long-term survival after pulmonary metastasectomy for renal cell carcinoma?. Ann Thorac Surg 2005; 79: 996-1003
  • 12 Hofmann HS, Neef H, Krohe K. et al. Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. Eur Urol 2005; 48: 77-81 ; discussion 81-72
  • 13 Pfannschmidt J, Klode J, Muley T. et al. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients. Ann Thorac Surg 2006; 81: 448-454
  • 14 Winter H, Meimarakis G, Angele MK. et al. Tumor infiltrated hilar and mediastinal lymph nodes are an independent prognostic factor for decreased survival after pulmonary metastasectomy in patients with renal cell carcinoma. J Urol 2010; 184: 1888-1894
  • 15 Kanzaki R, Higashiyama M, Fujiwara A. et al. Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience. Eur J Cardiothorac Surg 2011; 39: 167-172
  • 16 Meimarakis G, Angele M, Staehler M. et al. Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases. Am J Surg 2011; 202: 158-167
  • 17 Kawashima A, Nakayama M, Oka D. et al. Pulmonary metastasectomy in patients with renal cell carcinoma: a single-institution experience. Int J Clin Oncol 2011; 16: 660-665
  • 18 Bolukbas S, Kudelin N, Eberlein M. et al. The influence of the primary tumor on the long-term results of pulmonary metastasectomy for metastatic renal cell carcinoma. Thorac Cardiovasc Surg 2012; 60: 390-397
  • 19 Renaud S, Falcoz PE, Alifano M. et al. Systematic lymph node dissection in lung metastasectomy of renal cell carcinoma: an 18 years of experience. J Surg Oncol 2014; 109: 823-829
  • 20 Meacci E, Nachira D, Congedo MT. et al. Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience. J Thorac Dis 2017; 9: S1267-S1272
  • 21 Cerfolio RJ, Allen MS, Deschamps C. et al. Pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 1994; 57: 339-344
  • 22 Kavolius JP, Mastorakos DP, Pavlovich C. et al. Resection of metastatic renal cell carcinoma. J Clin Oncol 1998; 16: 2261-2266
  • 23 Pfannschmidt J, Hoffmann H, Muley T. et al. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 2002; 74: 1653-1657
  • 24 Assouad J, Petkova B, Berna P. et al. Renal cell carcinoma lung metastases surgery: pathologic findings and prognostic factors. Ann Thorac Surg 2007; 84: 1114-1120
  • 25 Zhao Y, Li J, Li C. et al. Prognostic factors for overall survival after lung metastasectomy in renal cell cancer patients: A systematic review and meta-analysis. Int J Surg 2017; 41: 70-77
  • 26 Kandioler D, Kromer E, Tuchler H. et al. Long-term results after repeated surgical removal of pulmonary metastases. Ann Thorac Surg 1998; 65: 909-912
  • 27 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms. Langversion 1.2, 2017, AWMF Registernummer: 043/017OL. http://leitlinienprogramm-onkologie.de/Nierenzellkarzinom.85.0.html
  • 28 Ljungberg B, Albiges L, Bensalah K. et al. EAU Guidelines on Renal Cell Carcinoma 2018. European Association of Urology Guidelines 2018 Edition. Arnhem, The Netherlands: European Association of Urology Guidelines Office; 2018