Palliative Chirurgie beim metastasierten Urothelkarzinom

Zusammenfassung

Palliative Chirurgie wird zur Linderung von Symptomen und auch zur Verbesserung des Überlebens bei einigen Tumorentitäten eingesetzt. Beim Urothelkarzinom ist die Rolle der palliativen Chirurgie ist gering und klinische Daten sind selten. Durch besseres Ansprechen auf systemische Therapien werden aber auch zunehmend chirurgische Interventionen im Rahmen von individuellen Behandlungskonzepten durchgeführt und anschließend als Fallserien publiziert. Bei niedriger Metastasenlast, bzw. bei Tumoren, die sich auf Lymphknoten, in- und außerhalb des Beckens, bzw. singuläre Metastasen in der Lunge beschränken, scheinen einige ausgewählte Patienten auch davon zu profitieren. Das Abschätzen von Nutzen und Risiko ist allerdings schwierig und muss für jeden Patienten neu überlegt werden, weshalb prospektive Studien vermutlich auch in Zukunft nicht existieren werden. Diese Übersichtsarbeit versucht, die wichtigsten Publikationen zu diesem Thema zusammenzufassen.

Abstract

Palliative surgery is performed in order to relieve symptoms as well as to increase survival in selected tumour entities. For urothelial cancer, its role is limited and clinical data are limited, too. Yet with better responses being achieved to systemic therapy, more and more surgical procedures are being carried out in the form of individualised treatment concepts and are then published as case series.

For patients with low metastatic load, or if the tumour is restricted to lymph nodes inside and outside the pelvis, as well as for singular pulmonary metastasis, there seems to be a survival benefit in select cases. Calculation of risks and benefits is difficult and, for now, should be reconsidered for every individual patient. Therefore, prospective trials are difficult to perform and should not be expected to exist in the future. This review aims to summarise the most important publications on this topic.

Schlüsselwörter

Urothelkarzinom - Lymphadenektomie - zytoreduktiv - palliativ

Keywords

urothelial cancer - lymphadenectomy - cytoreductive - palliative

• Literatur

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