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Organ erhaltende Nierentumorchirurgie

Nephron-sparing surgery

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Zusammenfassung

Die Organ erhaltende Nierentumorchirurgie hat in den letzten 20 Jahren immer mehr an Bedeutung gewonnen. Zunächst wurde sie unter imperativer Indikation zum Erhalt der Restnierenfunktion durchgeführt, mittlerweile wird aufgrund guter onkologischer Ergebnisse zunehmend auch unter elektiven Indikationsstellungen teilreseziert. Nach den neuen EAU-Leitlinien für Nierenzellkarzinome hat sich die Nierenteilresektion bei Tumoren unter 4 cm und gesunder kontralateraler Niere – aufgrund zur Nephrektomie vergleichbar guter Ergebnisse – als Standardtherapie etabliert. In großen urologischen Zentren wird mittlerweile eine Teilresektion auch bei Tumoren über 4 cm bei günstiger Tumorlokalisation und entsprechender technischer Durchführbarkeit favorisiert – so genannte erweiterte elektive Indikationsstellung. Im Folgenden sollen die Indikationen zur Nierenteilresektion, das perioperative Vorgehen, verschiedene operative Techniken und Zugangswege sowie onkologische Ergebnisse vor dem Hintergrund der Daten aus der eigenen Klinik dargestellt werden.

Abstract

Over the last two decades, nephron-sparing surgery has gained more and more importance. Initially it was done for imperative indications to preserve the remaining function of solitary kidneys. Today, because of favourable oncological results, elective nephron-sparing surgery is increasingly performed. According to the latest European Association of Urology guidelines on renal cell carcinoma, nephron-sparing surgery for tumours less than 4 cm with a healthy contralateral kidney is considered the standard therapeutic option because of excellent postoperative outcome and favourable oncological results. At major urological institutions, nephron-sparing surgery is even offered to patients with tumours larger than 4 cm (easy access, with partial resection deemed oncologically and technically feasible) for so-called extended elective indications. This review summarises the indications, perioperative management, various surgical approaches and techniques, and oncological results for nephron-sparing surgery, briefly highlighting data from our own institution.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrbergerstraße, 66421, Homburg, Saar, Deutschland

    F. Becker, S. Siemer, J. Rotering, H. Suttmann & M. Stöckle

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  1. F. Becker
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  2. S. Siemer
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  3. J. Rotering
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  4. H. Suttmann
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  5. M. Stöckle
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Correspondence to F. Becker.

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Becker, F., Siemer, S., Rotering, J. et al. Organ erhaltende Nierentumorchirurgie. Urologe 47, 215–223 (2008). https://doi.org/10.1007/s00120-008-1651-3

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  • DOI: https://doi.org/10.1007/s00120-008-1651-3

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