Pulmonale Metastasenchirurgie des kolorektalen Karzinoms

Zusammenfassung

Die Behandlung von Patienten mit pulmonalen Metastasen bei kolorektalem Karzinom befindet sich in einer kontinuierlichen Weiterentwicklung. Dieses betrifft im Wesentlichen neue Substanzen im Bereich der systemischen Therapie. Für sorgfältig ausgewählte Patienten ist die chirurgische Entfernung von pulmonalen Metastasen ein wichtiger Bestandteil des interdisziplinären Therapiekonzepts; sie ist in den Leitlinien als primäre Therapie verankert. Publiziert sind 5-Jahres-Überlebensraten von bis zu 60 % nach pulmonaler Metastasektomie. Das parenchymsparende Entfernen der Metastasen hat sich hierbei als relativ risikoarmes Vorgehen etabliert. Prognostische Faktoren sind u. a. die komplette Resektion, positive thorakale Lymphknoten, die Anzahl der Metastasen, aber auch das krankheitsfreie Intervall. Diese Faktoren werden bei der Indikationsstellung genutzt, konnten allerdings bisher lediglich in retrospektiven Studien herausgearbeitet werden.

Abstract

Treatment strategies for patients with pulmonary metastases of colorectal carcinoma are continuously evolving. This applies mostly to new systemic therapeutic approaches. For carefully selected patients surgical removal of pulmonary metastases remains an important interdisciplinary therapeutic option and is recommended as first treatment option by the guidelines. Five-year survival rates of up to 60 % are reported following pulmonary metastasectomy. Parenchyma sparing resection has been well established in this setting with low morbidity and mortality. Prognostic factors are, among others, complete resection, thoracic lymph node involvement, the number of metastases and the disease free interval. Although data result mostly from retrospective studies, these factors currently help in patient selection.

Schlüsselwörter

Darmkrebs - Thoraxchirurgie - Lungenmetastasen - Metastasenchirurgie

Key words

lung metastasis - colon cancer - cancer surgery - thoracic surgery

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