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“Wait and see”-Strategie versus Lymphadenektomie im klinischen Stadium I nichtseminomatöser Hodentumoren

  • L. Weißbach
  • R. Bussar-Maatz
Conference paper

Zusammenfassung

Im klinischen Stadium I des Hodentumors erreichen modifizierte Lymphadenektomie (LA) und die Surveillance-Strategie Überlebensraten bis zu 99%. Durch die modifizierte LA werden die von der klinischen Diagnostik übersehenen retroperitonealen Metastasen sicher nachgewiesen. Unter Surveillance erleiden diese Patienten einen Progreß (17%), der eine aggressive Therapie erfordert. Etwa 15% der Patienten entwickeln bei beiden Strategien Lungenmetastasen. Unter Surveillance bleiben dem Patienten allgemeine Operationskomplikationen (12%) erspart; 100% haben eine erhaltene Ejakulation, während durch die mod. LA etwa 15% einen Ejakulationsverlust erleiden. Nach modifizierter LA reichen dreimonatliche Kontrolluntersuchungen über 2 Jahre beim niedergelassenen Urologen aus. Die Überwachung der Surveillance-Strategie muß in sehr viel engeren Abständen an einem onkologischen Zentrum erfolgen. Bis verläßliche Risikofaktoren für eine Metastasierung gefunden sind und damit das Stadium I besser definiert werden kann, bleibt die modifizierte LA Standardtherapie im Stadium I.

Abstract

In clinical stage I of testicular germ cell tumors, we are able to achieve survival rates up to 99% using modified lymphadenectomy (LA) or surveillance. Retroperitoneal lymph node metastases that are overlooked by clinical examination methods are detected by LA. Under surveillance about 17% of these patients relapse, making aggressive chemotherapy necessary. Pulmonary metastases develop with both strategies. Under surveillance there are no surgical complications, and all patients retain the ability to ejaculate, whereas modified LA causes ejaculation loss in 15%. After surgery follow-up every 3 months for 2 years by a local practitioner is sufficient. Follow-ups under surveillance should take place at much shorter intervals in an oncology unit. Therefore, modified LA must remain the standard therapy for stage I tumors until reliable risk factors for metastasizing are found and stage I can thus be better defined.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • L. Weißbach
  • R. Bussar-Maatz

There are no affiliations available

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