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[泌尿肿瘤学中的手术局限性]

[Limits of surgery in uro-oncology].

作者信息

Heidenreich A

机构信息

Klinik für Urologie, Uro-Onkologie, roboter-assistierte und spezielle urologische Chirurgie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.

Klinik für Urologie, Medizinische Universität Wien, Wien, Österreich.

出版信息

Urologe A. 2018 Sep;57(9):1058-1068. doi: 10.1007/s00120-018-0735-y.

Abstract

The limits of cancer surgery in uro-oncology are characterized by a carefully weighed risk of surgical feasibility and oncological necessity. The limits of uro-oncological cancer surgery do not represent fixed dogmas but ideally these more or less cognitive boundaries move based on new scientific findings, improved imaging modalities, optimized surgical techniques and perioperative care. The limits of cancer surgery are defined by patient-specific parameters, the biological aggressiveness of the tumor itself, the skills and expertise of the surgeon, and adequate perioperative care of the patient. Dependent on the origin of the cancers of the upper and lower urogenital tract, the specific particularities of each individual cancer in terms of prognosis need to be known, taking into consideration the newest molecular insights and modern multimodality treatment regimes. Only the consideration of the above mentioned basics will allow the best decision to be made with the patient concerning the optimal individual treatment. The current article highlights general parameters of the patient, tumor and surgeon which might define the limits of cancer surgery in uro-oncology. In addition, specific clinical scenarios are discussed with regard to surgery limits in cancer of the kidney, the prostate and the testis.

摘要

泌尿肿瘤学中癌症手术的局限性体现在手术可行性风险与肿瘤学必要性的审慎权衡上。泌尿肿瘤学癌症手术的局限性并非固定不变的教条,理想情况下,这些或多或少的认知边界会随着新的科学发现、改进的成像方式、优化的手术技术以及围手术期护理而发生变化。癌症手术的局限性由患者特定参数、肿瘤本身的生物学侵袭性、外科医生的技能和专业知识以及患者充分的围手术期护理所界定。根据上、下泌尿生殖道癌症的起源,需要了解每种癌症在预后方面的具体特点,同时考虑最新的分子见解和现代多模式治疗方案。只有考虑上述基本要素,才能与患者就最佳个体化治疗做出最佳决策。本文重点介绍了可能界定泌尿肿瘤学中癌症手术局限性的患者、肿瘤和外科医生的一般参数。此外,还讨论了肾、前列腺和睾丸癌手术局限性方面的具体临床情况。

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