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Chirurgie des lokalisierten Nierenzellkarzinoms

Surgery of localized renal cell carcinoma

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Das Nierenzellkarzinom ist in Deutschland die dritthäufigste maligne urologische Erkrankung. Die Inzidenz nimmt tendenziell zu und liegt gegenwärtig bei 22/100.000 Männer und 10/100.000 Frauen. Trotzdem findet sich eine rückläufige Mortalität mit 8/100.000 für Männer pro Jahr und 3/100.000 für Frauen pro Jahr. Hochwertige diagnostische Verfahren ermöglichen die Detektion kleiner asymptomatischer Tumoren. Entscheidend für die kurative Therapie des Nierentumors ist die komplette operative Resektion der Läsion.

Ziel

Ziel der Arbeit ist es, anhand aktueller Studien und Publikationen einen Überblick über die Diagnostik und Therapie kleiner lokal begrenzter Nierentumoren zu geben.

Material und Methoden

Die Autoren haben insgesamt 39 relevante Arbeiten zu diesem Themenkomplex im Rahmen einer selektiven Literaturrecherche in der Online-Datenbank Pubmed identifiziert, die erhobenen Daten zusammengetragen, bewertet und die entscheidenden Kernaussagen herausgearbeitet.

Ergebnisse und Schlussfolgerung

Die konsequente Weiterentwicklung wichtiger und hochwertiger diagnostischer Verfahren förderte die Implementierung einer risikoadaptierten Therapie gerade bei Patienten mit kleinen asymptomatischen Nierentumoren. Die radikale Nephrektomie galt lange Zeit als der Goldstandard in der Therapie des renalen Tumors. Zahlreiche Studien zeigen jedoch, dass die Nephrektomie langfristig mit relevanten Komorbiditäten vergesellschaftet ist. Operative Verfahren wie die Nierenteilresektion/Nierentumorenukleation – offen lumbal, laparoskopisch oder robotisch assistiert – sind dem klassischen Vorgehen in Outcome, Rezidivrate und Komplikationsrate bei verbessertem Komorbiditäten-Index gleichwertig oder gar überlegen.

Abstract

Background

The renal cell carcinoma is the third most common malignant urological disease in Germany. The incidence tends to increase and now stands at 22/100,000 men and 10/100,000 women. Nevertheless, there is a decline in mortality with 8/100,000 per year for men and 3/100,000 women per year. High-quality diagnostic methods enable the detection of small asymptomatic tumors. Decisive for the curative treatment of the kidney tumor is a complete surgical resection of the lesion.

Objective

The aim of this work is to provide an overview of the diagnostics and treatment of small localized renal tumors based on current studies and publications.

Material and methods

We have identified a total of 39 relevant papers on this topic in the context of a selective literature search in the online database PubMed. We evaluated the collated data and identified the crucial key messages.

Results and Conclusion

The consistent further development of important and high-quality diagnostic procedures promoted the implementation of a risk-adapted therapy even in patients with small asymptomatic renal tumors. Radical nephrectomy has long been considered the gold standard in the treatment of renal tumors. Numerous studies show that nephrectomy is associated with long-term relevant co-morbidities. Surgical procedures, such as nephron sparing surgery, done lumbar, laparoscopically or robotically assisted, are equivalent or even superior to the classical approach due to outcome, recurrence rate and complication rate.

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Einhaltung ethischer Richtlinien

Interessenkonflikte. T.J. Schnöller, M. Schrader und F. Jentzmik geben an, dass kein Interessenkonflikt besteht. Der Beitrag beinhaltet keine Studien an Menschen und Tieren.

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  1. Abteilung Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland

    T.J. Schnöller, M. Schrader & F. Jentzmik

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  1. T.J. Schnöller
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  2. M. Schrader
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  3. F. Jentzmik
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Correspondence to T.J. Schnöller.

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Schnöller, T., Schrader, M. & Jentzmik, F. Chirurgie des lokalisierten Nierenzellkarzinoms. Onkologe 21, 22–27 (2015). https://doi.org/10.1007/s00761-014-2774-3

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  • DOI: https://doi.org/10.1007/s00761-014-2774-3

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