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Der Chirurg

, Volume 90, Issue 1, pp 9–14 | Cite as

Resektionsstrategie bei Nebennierenrindenkarzinomen

  • S. Schimmack
  • O. Strobel
Leitthema
  • 62 Downloads

Zusammenfassung

Nebennierenrindenkarzinome (ACC) sind seltene und aggressive Neoplasien, die aufgrund einer hohen Lokalrezidiv- und Metastasierungsrate (bis zu 85 %) mit einer sehr begrenzten Überlebenszeit assoziiert sind. So liegt das 5‑Jahres-Überleben bei Patienten mit ACC und Lymphknotenmetastasen oder lokaler Infiltration bei 50 %, mit Fernmetastasen unter 15 %. Die einzige kurative Option und sinnvolle Therapiemöglichkeit ist eine R0-Resektion mit lokoregionärer und renohilärer sowie paraaortokavaler Lymphadenektomie. Die Therapie solcher Patienten sollte daher in Zentren geplant und durchgeführt werden. Auch bei einem Lokalrezidiv oder Fernmetastasen sollte eine mit neoadjuvanter/adjuvanter Chemotherapie und/oder Radiatio kombinierte R0-Resektion angestrebt werden. Im Falle eines asymptomatischen nichtresektablen Befundes ist von einer Debulking-Operation abzuraten. Die Primäroperation kann auch minimalinvasiv erfolgen, jedoch nur wenn dabei die onkologischen Prinzipien eingehalten werden (Radikalität, Intaktheit der Kapsel, Lymphadenektomie), da gezeigt wurde, dass das Überleben nach offener und minimalinvasiver Resektion vergleichbar ist. Eine palliative Resektion ist nur bei Symptomatik angezeigt.

Schlüsselwörter

R0-Resektion Lymphadenektomie Rezidiv Adrenalektomie Onkologische Prinzipien 

Resection strategies for adrenocortical carcinoma

Abstract

Adrenocortical carcinomas (ACC) are rare and aggressive neoplasms. Due to their high rate of local recurrence and distant metastases (up to 85%) they are associated with a poor survival. The 5‑year survival in ACC patients with lymph node metastasis or local infiltration is 50% and with distant metastasis less than 15%. An R0 resection with locoregional and para-aortic/paracaval lymphadenectomy is the only curative option and reasonable treatment possibility. The treatment of these patients should therefore be planned and carried out in centers. Local recurrences and distant metastases should also be treated with R0 resection when feasible, combined with neoadjuvant/adjuvant chemotherapy and/or radiation. In the case of an asymptomatic non-resectable ACC, debulking operations cannot be recommended. The primary operation can also be done in a minimally invasive procedure if principles of oncological surgery are followed (radical resection, no damage of the tumor capsule, lymphadenectomy), since survival after open and minimally invasive laparoscopic resection was comparable. Palliative resections are only indicated in symptomatic patients.

Keywords

R0 resection Lymphadenectomy Recurrence Adrenalectomy Oncologic principles 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Schimmack und O. Strobel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral und TransplantationschirurgieUniversität HeidelbergHeidelbergDeutschland

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