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Der Chirurg

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Ergebnisse der N1- und N2-Chirurgie beim nichtkleinzelligen Lungenkarzinom

  • J. PfannschmidtEmail author
  • J. Kollmeier
Leitthema
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Zusammenfassung

Der Lymphknoten(LK)-Befall beim nichtkleinzelligen Lungenkarzinom weist innerhalb der N1- und N2-Deskriptoren eine erhebliche Heterogenität hinsichtlich der Lokalisation, der Anzahl der befallenen LK und des Umfangs an Masse und Volumen auf. In dem Versuch, dem unterschiedlichen Prognoseverhalten Rechnung zu tragen, ist die 8. Klassifikation des TNM mit Vorschlägen zu einer weiteren Stratifikation der N1- und N2-Stadien in N1a, N1b sowie N2a1, N2a2 und N2b publiziert worden. Ziel der Arbeit ist die Diskussion des Stellenwerts der Chirurgie beim nichtkleinzelligen Lungenkarzinom in den LK-metastasierten Stadien N1 und N2. Während Vorteile hinsichtlich des Gesamtüberlebens nach begleitender Chemotherapie für Patienten mit einer N1-metastasierten Situation und Operation gesehen wurden, konnten strahlentherapeutische Konzepte hier keinen Überlebensvorteil belegen. Für Patienten mit einer N2-Metastasierung ist die chirurgische Resektionsbehandlung eingebunden in ein multimodales Behandlungskonzept mit den Modalitäten der Chemo- und Strahlentherapie. Wichtig erscheint in diesen Fällen ein sorgfältiges Restaging nach durchgeführter neoadjuvanter Therapie, um Patienten, die für eine kurative (R0-)Resektion geeignet erscheinen, ein operatives Behandlungsangebot zu ermöglichen. Eine Pneumonektomie nach induktiver Chemo-Radio-Therapie sollte nur in spezialisierten Zentren und nur bei zu erwartender R0-Resektion durchgeführt werden, da für diese Patienten die Resektion mit einem hohen Risiko schwerer postoperativer Komplikationen einhergehen kann. Hinsichtlich der neuen Subtypisierung der N2-Befallssituation in N2a1, N2a2 und N2b sind zukünftig weitere adaptiert multimodale Therapiekonzepte zu erwarten. Auch für die Patienten im Stadium IIIA liegen erste Ergebnisse in der Anwendung der VATS („video-assisted thoracoscopic surgery“), RAST (roboter-assistierte thorakale Resektion) und Thorakotomie zur lokalen Resektion vor. Diese weisen darauf hin, dass zumindest in spezialisierten Zentren mit dem Einsatz der minimal-invasiven Techniken vergleichbare Ergebnisse gegenüber dem offenen Verfahren möglich sind.

Schlüsselwörter

Prognose Lymphknotenmetastase Chemo-Radio-Therapie Chirurgie TNM 

Results of N1 and N2 surgery in non-small cell lung cancer

Abstract

Lymph node involvement in non-small cell lung cancer shows considerable heterogeneity within the N1 and N2 descriptors with respect to localization, the number of lymph nodes affected and the extent of mass and volume. In an attempt to reflect the different prognostic behavior of lymph node metastases, the 8th classification of the TNM has been published with proposals for further subtyping of the N1 and N2 stages into N1a, N1b, as well as N2a1, N2a2, and N2b. The aim of this article is to discuss the value of surgery of non-small cell lung cancer in the N1 and N2 lymph node metastatic stages. While overall survival benefits were seen after concomitant chemotherapy for patients with N1 metastatic disease and surgery, radiotherapy concepts did not provide any survival benefit in this subgroup. For patients with N2 metastasis, surgical resection is part of a multimodal treatment concept with chemotherapy and radiotherapy. Careful restaging after neoadjuvant therapy is recommended in order to provide surgical treatment to patients deemed suitable for curative (R0) resection. In particular, it should be noted that after inductive chemoradiotherapy, patients should only be treated by pneumonectomy in specialized centers, as resection can be associated with a high risk of postoperative complications. With respect to the new subtyping of the N2 involvement situation in N2a1, N2a2, and N2b, further adapted multimodal treatment concepts are expected in the future. Initial results are reported for stage IIIA patients and the use of video-assisted thoracoscopic surgery (VATS), robotic assisted thoracic surgery (RAST) and thoracotomy for local resection. These indicate that the use of minimally invasive techniques can achieve comparable results to open thoracotomy procedures, at least in specialized treatment centers.

Keywords

Prognosis Lymph node metastases Chemoradiotherapy Surgery TNM 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Kollmeier: Berater- bzw. Referententätigkeit für Roche Pharma AG, Boehringer Ingelheim, Bristol-Meyers Squibb, MSD, Takeda und Lilly Oncology in den letzten 5 Jahren. Keine persönlichen Honorare. J. Pfannschmidt gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Thoraxchirurgie, Lungenklinik HeckeshornHELIOS Klinikum Emil von BehringBerlinDeutschland
  2. 2.Klinik für PneumologieLungenklinik HeckeshornBerlinDeutschland

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