Die präoperative Evaluation erwachsener thoraxchirurgischer Patienten mit onkologisch resektablen Lungentumoren – eine gemeinsame Empfehlung der DGAI, DGT und DGP

Jerome Defosse; Vera von Dossow; Wojciech Dudek; Michael Halank; Torsten Loop; Erich Stoelben; Michael Westhoff

doi:10.1055/a-2637-5718

Pneumologie
DOI: 10.1055/a-2637-5718

Empfehlungen

Die präoperative Evaluation erwachsener thoraxchirurgischer Patienten mit onkologisch resektablen Lungentumoren – eine gemeinsame Empfehlung der DGAI, DGT und DGP^[*]

Presurgical evaluation of adult thorax-surgery patients with oncologically resectable tumours – a joint recommendation of DGAI, DGT and DGP

Authors

Jerome Defosse

¹Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Köln Merheim, Universität Witten/Herdecke, Köln, Deutschland
Vera von Dossow

²Institut für Anästhesiologie und Schmerztherapie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-Universität Bochum, Bochum, Deutschland
Wojciech Dudek

³Abteilung Thoraxchirurgie, Lungenklinik Hemer, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
Michael Halank

⁴Medizinische Klinik und Poliklinik I, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Deutschland
Torsten Loop

⁵Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
Erich Stoelben

⁶Thoraxklinik Köln, Thoraxchirurgie, Cellitinnen-Krankenhaus St. Hildegardis-Krankenhaus, Köln, Deutschland
Michael Westhoff

⁷Klinik für Pneumologie, Intensiv-/Beatmungs- und Schlafmedizin, Lungenklinik Hemer, Universität Witten/Herdecke, Hemer, Deutschland

Abstract

Zusammenfassung

Die steigende Inzidenz maligner Lungenerkrankungen sowie neoadjuvanter Therapien und eine durch das zukünftige Lungenkarzinom-Screening zu erwartende Detektion von operablen Stadien erfordern vor dem Hintergrund einer Zunahme von Atemwegserkrankungen, speziell der chronisch obstruktiven Lungenerkrankung (COPD), aber auch interstitieller Lungenerkrankungen, differenzierte präoperative Entscheidungen über eine funktionelle Operabilität.

Da das postoperative Risiko für kardiovaskuläre und pulmonale Komplikationen nach einer Lungenresektion mit dem Ausmaß der Lungenparenchymresektion und der vorbestehenden Einschränkung der Organfunktionen von Herz, Lunge, Niere und Stoffwechsel steigt, bedürfen auch diese einer besonderen Beachtung. Dies gilt angesichts einer steigenden Anzahl älterer Patienten über 75 Jahren ebenso für das „Gebrechlichkeitssyndrom“ („Frailty“), das einen weiteren wesentlichen Parameter bei der strukturierten Evaluation darstellt.

Die aktuelle Empfehlung soll eine valide und fundierte Entscheidungsgrundlage über die funktionelle Operabilität eines Patienten mit einem chirurgisch und onkologisch resektablen Lungentumor aus pneumologischer, thoraxchirurgischer und anästhesiologischer Perspektive schaffen.

Abstract

The increasing incidence of malignant lung diseases, neoadjuvant therapies, and the expected detection of operable stages through future lung cancer screening require differentiated preoperative decisions regarding functional operability against the background of an increase in respiratory diseases, especially COPD, but also interstitial lung diseases.

Since the postoperative risk of cardiovascular and pulmonary complications after lung resection increases with the extent of lung parenchymal resection and the pre-existing impairment of organ function of the heart, lungs, kidneys, and metabolism, these also require special attention. Given the increasing number of elderly patients over 75 years of age, this also applies to frailty, which represents another key parameter in structured evaluation.

Full Text

References

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Die präoperative Evaluation erwachsener thoraxchirurgischer Patienten mit onkologisch resektablen Lungentumoren – eine gemeinsame Empfehlung der DGAI, DGT und DGP[*]

Authors

Die präoperative Evaluation erwachsener thoraxchirurgischer Patienten mit onkologisch resektablen Lungentumoren – eine gemeinsame Empfehlung der DGAI, DGT und DGP^[*]