Zusammenfassung
Die Prognose und optimale Behandlung des Morbus Hodgkin werden entscheidend vom Ausbreitungsstadium
der Erkrankung bestimmt. Das Ziel der Behandlung ist die Heilung, die durch eine Chemo-Strahlentherapie
mit akzeptabler akuter und Langzeit-Toxizität erreicht werden kann. Diese Übersichtsarbeit
beschreibt den Einsatzbereich chirurgischer Verfahren in der Diagnostik und Therapie
des M. Hodgkin und geht explizit auf die gängigen Techniken der oberflächlichen Lymphknotenbiopsien
am Hals, Axilla und Leiste sowie thorakoskopische und laparoskopische Techniken, u.
a. der Splenektomie und der ovariellen Transposition ein. In den letzten Jahren hat
sich die Rolle der Chirurgie in der Diagnostik und Behandlung des M. Hodgkin wegen
der unzureichenden Probengewinnung bei der Feinnadelbiopsie, der verbesserten Bildgebung
und der raschen Verbreitung endoskopischer Verfahren sowie sich verändernder Therapiekonzepte
mit zunehmender systemischer Behandlung in Frühstadien, erheblich gewandelt. Zusammengefasst
hat das chirurgische Staging seine Rolle als unumgängliches Verfahren in der Diagnostik
des M. Hodgkin verloren. Bei ausgewählten Fällen hat die minimalinvasive Chirurgie
die Feinnadelbiopsie genauso wie die Thorakotomie und Laparotomie ersetzt, da sie
- bei gleicher Treffsicherheit - eine im Vergleich geringere Morbidität zur Folge
hat. Die minimalinvasive Chirurgie beim M. Hodgkin kann technisch anspruchsvoll sein,
zumal der einzelne Chirurg darin selten größere Erfahrung erlangen dürfte. Dies und
die Notwendigkeit einer noch intraoperativen histologischen Begutachtung lassen eine
Konzentrierung dieser Eingriffe auf thorakoskopisch und laparoskopisch erfahrene Zentren
für sinnvoll erachten.
Abstract
The stage of Hodgkin's disease (HD) determines the treatment plan and prognosis. The
treatment goal is cure, which can be achieved with an acceptable immediate and late
toxicity. The most important treatment modalities are chemo- and radiotherapy. In
recent years, the role of surgery in diagnosis and treatment of HD has changed due
to insufficiency of fine needle biopsy, improvement of diagnostic imaging, development
of endoscopic procedures and current concepts favouring treatment in earlier stages.
This review focuses on the recent advances of surgery in diagnosis and therapy of
HD and describes and illustrates in detail the technique of superficial lymph node
biopsy of the neck axilla and inguinal region, thoracoscopic and laparoscopic diagnostic
procedures as well as the laparoscopically assisted splenectomy and ovarian transposition.
Overall, surgical staging has lost its position as an essential tool in diagnosis
of HD. For selected indications minimally invasive surgery has replaced fine needle
biopsy as well as conventional laparotomy and thoracotomy as it yields a diagnosis
in almost all cases at a comparatively lower morbidity. Minimally invasive surgery
in HD can be technically demanding in which individual surgeons will hardly ever reach
extensive experience. This and the necessity of immediate intraoperative sectioning
by an experienced pathologist make it seem useful to focus on centres specialised
in laparoscopic and thoracoscopic techniques.
Schlüsselwörter:
Morbus Hodgkin - Diagnostik - Therapie - Minimal invasive Chirurgie - Konventionelle
Chirurgie
Key words:
Hodgkin's disease - Diagnosis - Therapy - Minimal invasive surgery - Conventional
surgery
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Priv.-Doz. Dr. med. Markus Golling
Department of Surgery Division of Surgical Oncology University of Heidelberg
Im Neuenheimer Feld 110 69120 Heidelberg
Telefon: + 49-6221-566292 or 566110
Fax: + 49-6221-564215
eMail: Markus_Golling@med.uni-heidelberg.de