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Aktuelle Urol 2019; 50(04): 366-377
DOI: 10.1055/a-0884-2792
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Operative Therapie des Harnblasenkarzinoms: Fortschritte der letzten 50 Jahre

Surgical treatment of bladder cancer: advances made in the past 50 years
Christian Bolenz
Universitätsklinikum Ulm, Klinik für Urologie und Kinderurologie, Ulm
,
Richard E. Hautmann
Universitätsklinikum Ulm, Klinik für Urologie und Kinderurologie, Ulm
› Author Affiliations
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Publication History

Publication Date:
15 May 2019 (online)

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Zusammenfassung

Innerhalb der letzten 5 Jahrzehnte wurden bei der operativen Therapie des Harnblasenkarzinoms enorme Behandlungsfortschritte erzielt. Diese haben die Morbidität und Mortalität der Erkrankung deutlich reduziert. Neben einem kontinuierlich zunehmenden Verständnis der Tumorbiologie trugen zu einer erfolgreicheren Behandlung viele Neuentwicklungen endoskopischer Instrumente und Methoden sowie neue chirurgische Techniken für die radikale Zystektomie (RZ) bei. Durch eine bessere klinisch-pathologische Risikostratifizierung der Patienten stehen mittlerweile unterschiedliche Behandlungspfade zur Verfügung. Diese reichen von wiederholten endoskopischen Resektionen über eine risikoadaptierte adjuvante Instillationstherapie bis hin zur RZ, die darüber hinaus Bestandteil eines multimodalen kurativen Konzeptes sein kann. Zum 50-jährigen Jubiläum der Aktuellen Urologie geben wir einen Überblick über die wichtigsten Fortschritte seit dem Jahr 1969 und die aktuellen Entwicklungen bei der operativen Therapie des Harnblasenkarzinoms. Moderne endoskopische Bildgebungsverfahren („enhanced cystoscopy“) und das molekulare Subtyping verbessern die Risikoeinschätzung. Außerdem bestehen erste Erfahrungen mit der roboterassistierten RZ, neue Tendenzen zur Standardisierung von Techniken, ein verbessertes perioperatives Management sowie Initiativen zur Qualitätsmessung von funktionellem und onkologischem Outcome. All diese Entwicklungen werden die Lebensqualität und die Heilungsraten von Patienten mit einem Harnblasenkarzinom weiter verbessern.

Abstract

The past 5 decades have seen major advances in the surgical treatment of bladder cancer, which have significantly reduced the morbidity and mortality of the disease. Enhanced understanding of tumour biology as well as a large number of newly developed endoscopic instruments and techniques have contributed to making treatment more successful. Moreover, modified and improved surgical techniques of radical cystectomy have been implemented and the clinical and pathological risk stratification of patients has been improved. Hence, patients are treated differently according to risk groups. Treatment algorithms range from repeated transurethral resections to adjuvant intravesical therapy to radical cystectomy, which may be part of a multimodal approach with curative intent. Celebrating the 50th anniversary of “Aktuelle Urologie”, we summarise the most important advances in the treatment of BC since 1969 and report some current trends. Modern endoscopic imaging techniques (“enhanced cystoscopy”) and molecular subtyping of BC may further improve risk stratification. Moreover, some initial experience has been made with robot-assisted radical cystectomy, and there are new trends for the standardisation of techniques, concepts of enhanced recovery after surgery, as well as initiatives for the measurement of surgical quality and patient-reported outcomes. We believe that all these current developments may help to further improve the quality of life and therapeutic outcome of patients with BC.

Schlüsselwörter

Harnblasenkarzinom - Urothelkarzinom - chirurgische Therapie - Tumoren des Urogenitaltraktes - Harnableitung

Keywords

bladder cancer - urothelial carcinoma - surgical treatment - neoplasms of the urinary tract - urinary diversion
 

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