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Pneumologie 2015; 69(03): 165-176
DOI: 10.1055/s-0034-1391100
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© Georg Thieme Verlag KG Stuttgart · New York

Thoraxchirurgisches Staging des Lungenkarzinoms

Surgical Staging of Lung Cancer
M. R. Müller
Abteilung für Thoraxchirurgie, Otto-Wagner-Spital, Wien
,
S. B. Watzka
Abteilung für Thoraxchirurgie, Otto-Wagner-Spital, Wien
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
06. März 2015 (online)

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Zusammenfassung

Die korrekte Definition des Erkrankungsstadiums (Staging) ist die Voraussetzung für eine stadiengerechte und damit optimale Behandlung des Lungenkarzinoms. Dies wird heute an spezialisierten Zentren mittels moderner bildgebender oder minimal-invasiver Verfahren realisiert. Trotzdem spielt die Thoraxchirurgie nicht nur in der Behandlung, sondern auch im Staging des Lungenkarzinoms eine wesentliche Rolle. Die Indikation zum thoraxchirurgischen Staging des Lungenkarzinoms besteht in der Regel immer dann, wenn es auf radiologisch und endoskopisch-interventionellem Wege nicht möglich ist, suffizientes Gewebematerial für eine konklusive Diagnostik der Lymphknotenstationen und/oder suszipierter metastatischer Herde zu bekommen. Die dazu verwendeten Methoden sind die zervikale und erweiterte Mediastinoskopie, die Video-assistierte mediastinale Lymphadenektomie (VAMLA), die anteriore Mediastinotomie nach Chamberlain und die Video-assistierte Thorakoskopie (VATS). Bei der Indikationsstellung zu invasiven Verfahren muss darauf geachtet werden, dass der erzielbare diagnostische Mehrwert jeweils mit einem therapeutischen Mehrwert für den Patienten einhergeht.

Abstract

Proper staging of lung cancer represents the basis for any stage-adapted and optimized treatment. This is today implemented in specialized centers mainly through the use of modern imaging methods and minimally-invasive measures. However, general thoracic surgery has a role not only in the therapeutic management of lung cancer, but offers additional staging information whenever endoscopic or interventional methods fail to achieve representative tissue biopsies of mediastinal lymph nodes or suspect lesions for conclusive diagnosis. The thoracic surgical armentarium comprises of cervical or extended mediastinoscopy, video-assisted mediastinal lymphadenectomy (VAMLA), anterior mediastinotomy (Chamberlain procedure) and video-thoracoscopy (VATS). Indications for any invasive diagnostic methods always have to respect a therapeutic benefit for the patient.

 

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