Khuyến nghị của AGO về liệu pháp phẫu thuật ung thư vú: Cập nhật 2022

Geburtshilfe und Frauenheilkunde - Tập 82 Số 10 - Trang 1031-1043 - 2022
Maggie Banys‐Paluchowski1, Marc Thill2, Thorsten Kühn3, Nina Ditsch4, Jörg Heil5, Achim Wöckel6, Eva Maria Fallenberg7, Michael Friedrich8, Sherko Kümmel9, Volkmar Müller10, Wolfgang Janni11, Ute‐Susann Albert6, Ingo Bauerfeind12, Jens‐Uwe Blohmer13, Wilfried Budach14, Peter Dall15, Peter A. Fasching16, Tanja Fehm17, Oleg Gluz18, Nadia Harbeck19, Jens Huober20, Christian Jackisch21, Cornelia Kolberg‐Liedtke22, Hans Kreipe23, David Krug24, Sibylle Loibl25,26, Diana Lüftner27, Michael P. Lux28, Nicolaì Maass29, Christoph Mundhenke30, Ulrike Nitz18, Tjoung Won Park-Simon31, Toralf Reimer32, Kerstin Rhiem33, Achim Rody1, Marcus Schmidt34, Andreas Schneeweiß35, Florian Schütz36, Hans‐Peter Sinn37, Christine Solbach38, Erich‐Franz Solomayer39, Elmar Stickeler40, Christoph Thomssen41, Michael Untch42, Isabell Witzel10, Bernd Gerber32
1Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
2Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
3Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
4Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
5Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
6Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
7Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
8Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
9Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
10Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
11Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
12Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
13Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
14Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
15Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
16Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
17Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
18Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
19Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
20Brustzentrum, Kantonspital St. Gallen, St. Gallen, Schweiz
21Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
22Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
23Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
24Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
25German Breast Group c/o GBG Forschungs GmbH, Neu-Isenburg, Neu-Isenburg, Germany
26Zentrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Goethe Universität Frankfurt am Main, Frankfurt am Main, Germany
27Medical University of Brandenburg Theodor-Fontane & Immanuel Hospital Märkische Schweiz, Buckow, Germany
28Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
29Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
30Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
31Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
32Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
33Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
34Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
35Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
36Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
37Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
38Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
39Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
40Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
41Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
42Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany

Tóm tắt

Tóm tắtKhuyến nghị của Ủy ban Ung thư Vú AGO về liệu pháp phẫu thuật cho ung thư vú đã được cập nhật lần cuối vào tháng 3 năm 2022 (www.ago-online.de). Do liệu pháp phẫu thuật là một trong nhiều bước trong điều trị ung thư vú, nên kinh nghiệm chẩn đoán và ung thư học phong phú của bác sĩ phẫu thuật vú và sự hợp tác liên ngành tốt với các bác sĩ chẩn đoán hình ảnh là rất quan trọng. Những thay đổi quan trọng nhất liên quan đến các kỹ thuật định vị, rìa cắt, quản lý nách trong bối cảnh điều trị tiền phẫu và đánh giá các lưới trong phẫu thuật tái tạo. Dựa trên các phân tích tổng hợp từ các nghiên cứu ngẫu nhiên, mức độ khuyến nghị cho siêu âm vú trong phẫu thuật để định vị các tổn thương không sờ thấy đã được nâng lên thành “++”. Do đó, kỹ thuật này được coi là tương đương với việc định vị bằng dây, miễn là đó là một tổn thương có thể được thể hiện tốt bằng siêu âm, bác sĩ phẫu thuật có kinh nghiệm phong phú trong siêu âm vú và có quyền truy cập vào thiết bị siêu âm phù hợp trong quá trình phẫu thuật. Đối với ung thư vú xâm lấn, mục tiêu là đạt được rìa cắt âm tính (“không có khối u trên mực mực”), bất kể liệu có thành phần nội nhú rộng hay không. Các ca phẫu thuật oncoplastic cũng có thể thay thế cho phẫu thuật cắt bỏ vú trong các trường hợp được chọn nhờ vào số lượng kỹ thuật hiện có, và tương đương với phẫu thuật cắt khối trong việc đảm bảo ung thư với tỷ lệ biến chứng tương đương. Phẫu thuật cắt hạch bạch huyết chẩn đoán được khuyến nghị cho bệnh nhân có tình trạng cN0 nhận hóa trị liệu neoadjuvant sau khi hoàn thành hóa trị. Sinh thiết xâm lấn tối thiểu được khuyến nghị cho các hạch bạch huyết nghi ngờ ban đầu. Sau khi hóa trị neoadjuvant, những bệnh nhân có 1 – 3 hạch bạch huyết nghi ngờ ban đầu và có đáp ứng tốt (ycN0) có thể nhận cắt bỏ hạch nách có mục tiêu và cắt bỏ hạch nách như các tùy chọn tương đương.

Từ khóa


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Geburtshilfe und Frauenheilkunde

Tập 82 Số 10

1031-1043

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