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

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.

Publication History

Article published online:
08 August 2025

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