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TumorDiagnostik & Therapie 2002; 23(1): 17-23
DOI: 10.1055/s-2002-20399
Review/Übersicht
© Georg Thieme Verlag Stuttgart · New York

Surgery in Diagnosis and Therapy of Hodgkin's Disease

Chirurgische Verfahren in Diagnostik und Therapie des M. HodgkinM.  Golling1 , G.  Egerer2 , T.  Lehnert1
  • 1Department of Surgery, Division of Surgical Oncology, Heidelberg
  • 2Department of Haematology and Oncology, Heidelberg
A similar review article has been published in German language in the journal Copyright permission has been given by the Springer Verlag to use the previously published pictures in the article by M. Golling, G. Egerer, Th. Lehnert, M. Hodgkin - Chirurgische Verfahren in Diagnostik und Therapie; Onkologe, 2000 (6): 1151 - 1159.
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Publication History

Publication Date:
27 February 2002 (online)

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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

Phone: + 49-6221-566292 or 566110

Fax: + 49-6221-564215

Email: Markus_Golling@med.uni-heidelberg.de

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