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Outcome und Lebensqualität nach resezierenden lungenchirurgischen Verfahren beim Lungenkarzinom

Outcome and quality of life after surgical lung resection procedures for lung cancer

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Der Pneumologe Aims and scope

Zusammenfassung

Die Bedeutung der Lebensqualität hat in den letzten Jahrzehnten im medizinischen Denken stark an Bedeutung gewonnen und ist neben dem Langzeitüberleben zum zweitwichtigsten Pfeiler und Parameter in der Gesamtbeurteilung für das Outcome eines Patienten geworden. Patienten mit Lungenkarzinom können in Abhängigkeit ihres Tumorstadiums sowohl in der Prognose als auch in der Symptomatik der Erkrankung ganz erhebliche Unterschiede aufweisen, die die individuelle Qualität des Lebens fundamental beeinflussen. Qualität ist jedoch ein abstrakter Begriff und deren Messung schwierig. Für die Erfassung der Lebensqualität von Lungenkarzinompatienten wurden deshalb von der European Organisation for Research and Treatment of Cancer (EORTC) die Standardfragebögen QLQ-C30 und QLQ-LC13 entwickelt, die sich in den letzten 20 Jahren als klinisch relevant und für die Bewertung nützlich erwiesen haben. In Metaanalysen wurde die präoperative exspiratorische Einsekundenkapazität (FEV1) der Patienten als negativer prädiktiver Wert für eine reduzierte Lebensqualität identifiziert. Das Alter des Patienten spielt hingegen für die Prognose der Lebensqualität keine Rolle. Um den unmittelbaren postoperativen negativen Effekt der Operation auf die Lebensqualität weiter zu minimieren, hat die Thoraxchirurgie in den letzten Jahrzehnten durch technische Neuerungen (videoassistierte Thoraxchirurgie [VATS], Roboterchirurgie) wesentliche Fortschritte unternommen.

Abstract

Over the past decades the quality of life has become increasingly more important in medical trains of thought and apart from long-term survival has become the second most important cornerstone and parameter in the total assessment for the outcome of patients. Patients with lung cancer can show substantial differences in the prognosis and the symptoms of the disease depending on the tumor stage, which fundamentally influence the individual quality of life; however, quality of life is an abstract term and measurement is difficult. The standard questionnaires QLQ-C30 and QLQ-LC13 of the European Organisation for Research and Treatment of Cancer (EORTC) were therefore developed for collation of the quality of life of lung cancer patients, which over the last 20 years have proven to be clinically relevant and useful for the assessment. In meta-analyses the preoperative forced expiratory volume in 1 s (FEV1) was identified as having a negative predictive value for a reduced quality of life. In contrast, the age of patients does not play any role in the prognosis on the quality of life. In order to further minimize the immediately postoperative negative effect of the operation on the quality of life, in recent decades thoracic surgery has undergone substantial progress by the introduction of novel techniques, such as video-assisted thoracic surgery (VATS).

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Abb. 1

Abbreviations

DASS-21:

Depression Anxiety Stress Scales-21

EORTC:

European Organization for Research and Treatment of Cancer

FACT-L:

Functional Assessment of Cancer Therapy-Lung

FEV1 :

Forcierte end-expiratorische Vitalkapazität in 1 s

HD:

High Definition

LCSS:

Lung Cancer Symptom Scale

NSCLC:

Non small cell lung cancer (Nicht-kleinzelliges Lungenkarzinom)

PCS:

Physical Composite Score (Wertemittlung des SF-12)

QoL:

Quality of Life (Lebensqualität)

QLQ:

Quality of Life Questionnaire

RS:

Robotic Surgery

SF-12:

Short-form 12 health survey (Kurzform des SF-36)

SF-36:

Short-form 36 health survey

VATS:

Video-assisted Thoracic Surgery

3D:

Dreidimensional

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Correspondence to S. Limmer.

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S. Limmer gibt an, dass kein Interessenkonflikt besteht.

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B. Jany, Würzburg

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Limmer, S. Outcome und Lebensqualität nach resezierenden lungenchirurgischen Verfahren beim Lungenkarzinom. Pneumologe 13, 233–240 (2016). https://doi.org/10.1007/s10405-016-0048-z

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