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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
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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.

Schlüsselwörter

Nierenzellkarzinom - Metastasektomie - Lungenmetastasen

Keywords

metastasectomy - pulmonary metastases - renal cell carcinoma


Publication History

Article published online:
23 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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