Prinzipien der onkologischen Chirurgie bei Lungenmetastasen kindlicher solider Tumoren

Zusammenfassung

Bei der Behandlung von Kindern mit soliden Tumo­ren kommen Fernmetastasen regelmäßig vor. Die Lunge ist hierbei insgesamt gesehen der häufigste Metastasierungsort. Die korrekte Therapie von Lungenmetastasen stellt für die meisten kindlichen soliden Tumoren einen prognostischen Faktor dar. Die Behandlung von Lungen­metastasen ist in den einzelnen Protokollen der multizentrischen Therapieoptimierungsstudien generell geregelt. Dennoch gibt es zu den prinzipiellen chirurgischen Vorgehensweisen nur selten konkrete Angaben. Im vorliegenden Artikel sollen Prinzipien der Chirurgie von Lungenmetastasen kindlicher Tumoren vorgestellt werden. Die Prinzipien der Metastasenchirurgie der wichtigsten extrakraniellen kindlichen Tumoren werden dargestellt unter Einschluss der Diagnostik, Operationsvorbereitung sowie Aspekten der Durchführung der Operation. Spezielle Besonderheiten der einzelnen Entitäten werden diskutiert. Lungenmetastasen bei kindlichen soliden Tumoren können unabhängig vom Alter der Patienten mit gutem Outcome operiert werden. Auch eine hohe Anzahl von Metastasen kann chirurgisch ­saniert werden. Je nach Verteilung der Herde ­sollte die Sternotomie als Zugang in Erwägung ­gezogen werden. Die Chirurgie von Lungenmetastasen bei soliden kindlichen Tumoren ist unter Beachtung der chirurgischen Prinzipien eine ­sichere Methodik und hat einen positiven Einfluss auf die Prognose der Patienten. In Abhängigkeit von der Entität ist ein aggressives chirurgisches Vorgehen möglicherweise gerechtfertigt. Ein interdisziplinäres Vorgehen unter Einschluss der pädiatrischen Onkologie und Radiologie ist in jedem Fall anzustreben. 

Abstract

Distant metastases regularly occur in cases of pae­diatric solid tumours. Overall the most common localisation of metastases is the lung. The correct treatment of lung metastases represents a prognostic factor in most paediatric solid tumours. Guidelines for the therapy of lung metastases are commonly included in the protocols of the different multicentric treatment trials. How­ever, specific surgical aspects are usually not ­addressed in these protocols. The aim of this article is to present the principles of surgery for lung metastases in paediatric solid tumours. The principles of surgery for metastases of the most common extracranial paediatric solid tumours are presented including aspects of the diagnostic work-up, surgical preparations, and surgical procedures. Special points of interest are discussed focusing on the different entities. Surgery for lung metastases in paediatric solid tumours can be ­performed with a good surgical outcome regardless of the patients’ age. Large numbers of ­sequelae can be surgically excised. Depending on the localisation sternotomy is an option con­cerning the surgical approach. Surgery for lung metastases in paediatric solid tumours is a safe method when respecting the principles for the procedure. It has a positive influence on the pa­tients’ prognosis. An aggressive surgical proce­dure may be justified ­depending on the tumour entity. An interdisciplinary approach including paediatric oncology and radiology is mandatory in any case. 

Schlüsselwörter

Metastase - Thorakotomie - Tumorwachstum

Key words

metastasis - thoracotomy - tumour growth

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