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Wiener klinisches Magazin

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25.04.2023 | Thoraxchirurgie

Chirurgie des alten Menschen – Thoraxchirurgie

verfasst von: Dr. Jonas Peter Ehrsam, Univ. Prof. Dr. Clemens Aigner

Erschienen in: Wiener klinisches Magazin | Ausgabe 3/2023

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Zusammenfassung

Hintergrund

Eine Vielzahl thoraxchirurgisch relevanter Krankheitsbilder häuft sich mit steigendem Alter. Hohes Alter wird aber häufig als Kontraindikation für kurative Eingriffe oder größere operative Eingriffe per se gesehen.

Ziel der Arbeit

Darlegung der aktuellen relevanten Studienlage, Ableitung von Empfehlungen zur PatientInnenselektion sowie prä-, peri- und postoperativen Optimierung.

Material und Methoden

Auswertung der aktuellen Studienlage.

Ergebnisse

Wie aktuelle Daten zeigen, ist das Alter für die meisten thorakalen Erkrankungen allein kein Grund eine chirurgische Behandlung vorzuenthalten. Bei der Selektion gilt es viel mehr, Komorbiditäten, Gebrechlichkeit, Mangelernährung und kognitive Einschränkungen zu berücksichtigen. Eine Lobektomie oder Segmentresektion bei nichtkleinzelligem Lungenkrebs (NSCLC) im Stadium I kann bei gut selektionierten > 80-jährigen PatientInnen zu akzeptablen bis sogar vergleichbar guten Kurz- und Langzeitergebnissen führen wie bei jüngeren. Ausgewählte > 75-jährige PatientInnen mit NSCLC im Stadium II–IIIA können sogar von einer adjuvanten Chemotherapie profitieren. Nach guter Selektion sind Hochrisikoeingriffe wie eine Pneumonektomie bei > 70-Jährigen und pulmonale Endarteriektomie bei > 80-Jährigen ohne erhöhte Mortalitätsraten möglich. Und auch die Lungentransplantation kann bei gut selektionierten > 70-jährigen PatienInnen zu einem guten Langzeitergebnis führen. Minimal-invasive Operationsverfahren und nichtintubierte Anästhesie tragen zur Risikoreduktion bei marginalen PatientInnen bei.

Diskussion

In der Thoraxchirurgie ist nicht das numerische Alter, sondern das biologische Alter entscheidend. Zur Optimierung der Selektion, der Eingriffe, der Vor- und Nachbehandlung sowie der Lebensqualität sind angesichts der immer älter werdenden Bevölkerung dringend weitere Studien nötig.

Vorheriger Artikel Integrierter digitaler Operationssaal für die Optimierung der Kopf-Hals-Tumorchirurgie

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Titel: Chirurgie des alten Menschen – Thoraxchirurgie
verfasst von: Dr. Jonas Peter Ehrsam
Univ. Prof. Dr. Clemens Aigner
Publikationsdatum: 25.04.2023
Verlag: Springer Vienna
Erschienen in: Wiener klinisches Magazin / Ausgabe 3/2023
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI: https://doi.org/10.1007/s00740-023-00497-w

Springer Medizin Österreich

Zusammenfassung

Hintergrund

Ziel der Arbeit

Material und Methoden

Ergebnisse

Diskussion

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