S. Sponholz

Chirurgische Therapie von Lungenmetastasen

Surgical treatment of lung metastases from extrathoracic malignancies is an established procedure. Pulmonary metastases are common. Generally, lung metastases are located peripherally and are asymptomatic. Involvement of the bronchial system or infiltration of the chest wall can be symptomatic. The indications for resection are an interdisciplinary decision. Metastasectomy can be with curative or palliative intent. Prerequisitess for pulmonary metastasectomy are primary tumor under control, the absence of extrathoracic metastases, the lack of other promising treatment options, the possibility for complete resection and low perioperative risk. Extra-anatomic resections are common. Perioperative morbidity and mortality is low. A cure is possible in selected patients.ZusammenfassungDie chirurgische Therapie von Lungenmetastasen extrathorakaler Malignome ist etabliert. Eine pulmonale Metastasierung ist häufig. In der Regel sind Lungenmetastasen peripher gelegen und asymptomatisch. Durch Tumoreinbruch in das Bronchialsystem oder die Brustwand kann es zu Beschwerden kommen. Die Indikation zur Resektion wird interdisziplinär gestellt. Sie kann in kurativer und palliativer Intention erfolgen. Voraussetzung hierfür ist, dass der Primärtumor kontrolliert ist, dass extrathorakale Metastasen sowie alternative Erfolg versprechende Therapieformen fehlen und alle Metastasen komplett, mit vertretbarem allgemeinem und funktionellem Risiko, resezierbar sind. Es dominieren extraanatomische Resektionen. Die perioperative Morbidität und Mortalität ist niedrig. Es besteht bei einem selektionierten Patientenkollektiv die Möglichkeit der Kuration.AbstractSurgical treatment of lung metastases from extrathoracic malignancies is an established procedure. Pulmonary metastases are common. Generally, lung metastases are located peripherally and are asymptomatic. Involvement of the bronchial system or infiltration of the chest wall can be symptomatic. The indications for resection are an interdisciplinary decision. Metastasectomy can be with curative or palliative intent. Prerequisitess for pulmonary metastasectomy are primary tumor under control, the absence of extrathoracic metastases, the lack of other promising treatment options, the possibility for complete resection and low perioperative risk. Extra-anatomic resections are common. Perioperative morbidity and mortality is low. A cure is possible in selected patients.

Surgical therapy of lung metastases

Surgical treatment of lung metastases from extrathoracic malignancies is an established procedure. Pulmonary metastases are common. Generally, lung metastases are located peripherally and are asymptomatic. Involvement of the bronchial system or infiltration of the chest wall can be symptomatic. The indications for resection are an interdisciplinary decision. Metastasectomy can be with curative or palliative intent. Prerequisitess for pulmonary metastasectomy are primary tumor under control, the absence of extrathoracic metastases, the lack of other promising treatment options, the possibility for complete resection and low perioperative risk. Extra-anatomic resections are common. Perioperative morbidity and mortality is low. A cure is possible in selected patients.ZusammenfassungDie chirurgische Therapie von Lungenmetastasen extrathorakaler Malignome ist etabliert. Eine pulmonale Metastasierung ist häufig. In der Regel sind Lungenmetastasen peripher gelegen und asymptomatisch. Durch Tumoreinbruch in das Bronchialsystem oder die Brustwand kann es zu Beschwerden kommen. Die Indikation zur Resektion wird interdisziplinär gestellt. Sie kann in kurativer und palliativer Intention erfolgen. Voraussetzung hierfür ist, dass der Primärtumor kontrolliert ist, dass extrathorakale Metastasen sowie alternative Erfolg versprechende Therapieformen fehlen und alle Metastasen komplett, mit vertretbarem allgemeinem und funktionellem Risiko, resezierbar sind. Es dominieren extraanatomische Resektionen. Die perioperative Morbidität und Mortalität ist niedrig. Es besteht bei einem selektionierten Patientenkollektiv die Möglichkeit der Kuration.AbstractSurgical treatment of lung metastases from extrathoracic malignancies is an established procedure. Pulmonary metastases are common. Generally, lung metastases are located peripherally and are asymptomatic. Involvement of the bronchial system or infiltration of the chest wall can be symptomatic. The indications for resection are an interdisciplinary decision. Metastasectomy can be with curative or palliative intent. Prerequisitess for pulmonary metastasectomy are primary tumor under control, the absence of extrathoracic metastases, the lack of other promising treatment options, the possibility for complete resection and low perioperative risk. Extra-anatomic resections are common. Perioperative morbidity and mortality is low. A cure is possible in selected patients.

[Liver and lung metastases of colorectal cancer. Long-term survival and prognostic factors].

ZusammenfassungEinleitungDa die Resektion von Leber- und Lungenmetastasen eines kolorektalen Karzinoms noch nicht abgeschlossen untersucht ist, wurden in dieser Studie das Überleben und prognostische Faktoren bei diesem Patientengut untersucht.MethodenEs wurden retrospektiv die prospektiven Daten bei 52 Patienten mit Leber- und Lungenmetastasen eines kolorektalen Karzinoms, die von 1999 bis 2009 in kurativer Absicht an pulmonalen Metastasen operiert wurden, untersucht.ErgebnisseDas Gesamtüberleben lag im Median bei 64 Monaten. Das mediane Überleben für Patienten mit synchron entstandenen Leber- und Lungenmetastasen lag bei 63 Monaten (5-Jahres-Überlebensrate [JÜR] 54 %), bei metachron entstandenen Leber- und Lungenmetastasen bei 74 Monaten (5JÜR 58 %, p = 0,451). Es zeigte sich ein signifikant schlechteres Überleben, wenn die Primärtumorlokalisation im Rektum statt im Kolon lag (Median 81 vs. 38 Monate, p = 0,004), bei multiplen Lungenmetastasen (≥ 2 Metastasen; Median 74 vs. 59 Monate, p = 0,032) und bei Progress nach präoperativer Chemotherapie (Median 74 vs. 63 vs. 15 Monate, p < 0,001). Keinen signifikanten Einfluss auf das Überleben zeigten ein beidseitiger Lungenbefall, ein positiver thorakaler Lymphknotenstatus, ein thorakales Rezidiv und ein krankheitsfreies Intervall < 36 Monate.FazitDie Metastasenresektion bei Leber- und Lungenmetastasen eines kolorektalen Karzinoms ist bei selektierten Patienten mit einem guten Langzeitüberleben vergesellschaftet. Das Vorhandensein von Leber- und Lungenmetastasen stellt kein Ausschlusskriterium zur Metastasenresektion dar. Ebenso ist ein thorakaler Lymphknotenbefall kein Ausschlusskriterium. Als negative Prognosefaktoren zeigen sich die Primärtumorlokalisation im Rektum, multiple Lungenmetastasen und ein Progress nach präoperativer Chemotherapie. Der Progress unter präoperativer Chemothrapie ist als Ausschlusskriterium zur Metastatasektomie zu werten.AbstractIntroductionThe resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer.MethodsA retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999–2009 at a single institution was carried out.ResultsThe mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months.ConclusionMetastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.INTRODUCTION The resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer. METHODS A retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999-2009 at a single institution was carried out. RESULTS The mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months. CONCLUSION Metastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.

Leber- und Lungenmetastasen des kolorektalen Karzinoms

ZusammenfassungEinleitungDa die Resektion von Leber- und Lungenmetastasen eines kolorektalen Karzinoms noch nicht abgeschlossen untersucht ist, wurden in dieser Studie das Überleben und prognostische Faktoren bei diesem Patientengut untersucht.MethodenEs wurden retrospektiv die prospektiven Daten bei 52 Patienten mit Leber- und Lungenmetastasen eines kolorektalen Karzinoms, die von 1999 bis 2009 in kurativer Absicht an pulmonalen Metastasen operiert wurden, untersucht.ErgebnisseDas Gesamtüberleben lag im Median bei 64 Monaten. Das mediane Überleben für Patienten mit synchron entstandenen Leber- und Lungenmetastasen lag bei 63 Monaten (5-Jahres-Überlebensrate [JÜR] 54 %), bei metachron entstandenen Leber- und Lungenmetastasen bei 74 Monaten (5JÜR 58 %, p = 0,451). Es zeigte sich ein signifikant schlechteres Überleben, wenn die Primärtumorlokalisation im Rektum statt im Kolon lag (Median 81 vs. 38 Monate, p = 0,004), bei multiplen Lungenmetastasen (≥ 2 Metastasen; Median 74 vs. 59 Monate, p = 0,032) und bei Progress nach präoperativer Chemotherapie (Median 74 vs. 63 vs. 15 Monate, p < 0,001). Keinen signifikanten Einfluss auf das Überleben zeigten ein beidseitiger Lungenbefall, ein positiver thorakaler Lymphknotenstatus, ein thorakales Rezidiv und ein krankheitsfreies Intervall < 36 Monate.FazitDie Metastasenresektion bei Leber- und Lungenmetastasen eines kolorektalen Karzinoms ist bei selektierten Patienten mit einem guten Langzeitüberleben vergesellschaftet. Das Vorhandensein von Leber- und Lungenmetastasen stellt kein Ausschlusskriterium zur Metastasenresektion dar. Ebenso ist ein thorakaler Lymphknotenbefall kein Ausschlusskriterium. Als negative Prognosefaktoren zeigen sich die Primärtumorlokalisation im Rektum, multiple Lungenmetastasen und ein Progress nach präoperativer Chemotherapie. Der Progress unter präoperativer Chemothrapie ist als Ausschlusskriterium zur Metastatasektomie zu werten.AbstractIntroductionThe resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer.MethodsA retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999–2009 at a single institution was carried out.ResultsThe mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months.ConclusionMetastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.INTRODUCTION The resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer. METHODS A retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999-2009 at a single institution was carried out. RESULTS The mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months. CONCLUSION Metastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.

Therapie des Chylothorax

Chylothorax is an infrequent but important form of pleural effusion. The most common causes are of postoperative and neoplastic origin. No prospective or randomized trials have been performed to evaluate the available treatment options for chylothorax. The basic principles of conservative treatment include drainage of the effusion and dietary measures. Chylothorax is typically treated conservatively. In the case of failure of conservative treatment, interventional radiological or surgical procedures are applied. Untreated chylothorax has a high morbidity and mortality.ZusammenfassungDer Chylothorax ist eine seltene, aber wichtige Form des Pleuraergusses. Er ist in der Regel postoperativen oder neoplastischen Ursprungs. Zur Behandlung des Chylothorax existieren keine prospektiven oder randomisierten Studien. Basismaßnahmen beim Chylothorax beinhalten die Drainage des Ergusses sowie diätetische Maßnahmen. Vorrangig wird der Chylothorax konservativ therapiert. Beim Versagen der konservativen Therapiemaßnahmen kommen interventionell-radiologische und chirurgische Prozeduren zur Anwendung. Der Chylothorax hat eine hohe Morbidität und Mortalität.AbstractChylothorax is an infrequent but important form of pleural effusion. The most common causes are of postoperative and neoplastic origin. No prospective or randomized trials have been performed to evaluate the available treatment options for chylothorax. The basic principles of conservative treatment include drainage of the effusion and dietary measures. Chylothorax is typically treated conservatively. In the case of failure of conservative treatment, interventional radiological or surgical procedures are applied. Untreated chylothorax has a high morbidity and mortality.

Leber- und Lungenmetastasen des kolorektalen Karzinoms@@@Liver and lung metastases of colorectal cancer: Langzeitüberleben und Prognosefaktoren@@@Long-term survival and prognostic factors

ZusammenfassungEinleitungDa die Resektion von Leber- und Lungenmetastasen eines kolorektalen Karzinoms noch nicht abgeschlossen untersucht ist, wurden in dieser Studie das Überleben und prognostische Faktoren bei diesem Patientengut untersucht.MethodenEs wurden retrospektiv die prospektiven Daten bei 52 Patienten mit Leber- und Lungenmetastasen eines kolorektalen Karzinoms, die von 1999 bis 2009 in kurativer Absicht an pulmonalen Metastasen operiert wurden, untersucht.ErgebnisseDas Gesamtüberleben lag im Median bei 64 Monaten. Das mediane Überleben für Patienten mit synchron entstandenen Leber- und Lungenmetastasen lag bei 63 Monaten (5-Jahres-Überlebensrate [JÜR] 54 %), bei metachron entstandenen Leber- und Lungenmetastasen bei 74 Monaten (5JÜR 58 %, p = 0,451). Es zeigte sich ein signifikant schlechteres Überleben, wenn die Primärtumorlokalisation im Rektum statt im Kolon lag (Median 81 vs. 38 Monate, p = 0,004), bei multiplen Lungenmetastasen (≥ 2 Metastasen; Median 74 vs. 59 Monate, p = 0,032) und bei Progress nach präoperativer Chemotherapie (Median 74 vs. 63 vs. 15 Monate, p < 0,001). Keinen signifikanten Einfluss auf das Überleben zeigten ein beidseitiger Lungenbefall, ein positiver thorakaler Lymphknotenstatus, ein thorakales Rezidiv und ein krankheitsfreies Intervall < 36 Monate.FazitDie Metastasenresektion bei Leber- und Lungenmetastasen eines kolorektalen Karzinoms ist bei selektierten Patienten mit einem guten Langzeitüberleben vergesellschaftet. Das Vorhandensein von Leber- und Lungenmetastasen stellt kein Ausschlusskriterium zur Metastasenresektion dar. Ebenso ist ein thorakaler Lymphknotenbefall kein Ausschlusskriterium. Als negative Prognosefaktoren zeigen sich die Primärtumorlokalisation im Rektum, multiple Lungenmetastasen und ein Progress nach präoperativer Chemotherapie. Der Progress unter präoperativer Chemothrapie ist als Ausschlusskriterium zur Metastatasektomie zu werten.AbstractIntroductionThe resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer.MethodsA retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999–2009 at a single institution was carried out.ResultsThe mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months.ConclusionMetastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.INTRODUCTION The resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer. METHODS A retrospective review of a prospective database of 52 patients with liver and lung metastases from colorectal cancer, undergoing metastasectomy with curative intent from 1999-2009 at a single institution was carried out. RESULTS The mean overall survival (OS) was 64 months. For synchronous liver and lung metastases the mean overall survival was 63 months (5-year survival 54 %) and for metachronous liver and lung metastases 74 months (5-year survival 58 %, p = 0.451). A poor prognostic outcome was observed in cases of localization of the primary tumor in the rectum (OS 81 vs. 38 months, p = 0.004), with multiple lung metastases (≥ 2 metastases, OS 74 vs. 59 months, p = 0.032) and with disease progression after premetastasectomy chemotherapy (OS 74 vs. 63 vs. 15 months, p < 0.001). No influence on overall survival was detected for bilateral lung metastases, thoracic lymph node metastases, disease recurrence and disease-free interval < 36 months. CONCLUSION Metastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.

Surgical therapy of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring disease is expected to reach a peak in the coming 5 years. An R0 resection for MPM is technically impossible; therefore, the aim of surgical procedures is to achieve the maximum amount of cytoreduction. There are two established surgical techniques for treatment of MPM, extrapleural pneumonectomy and tumor pleurectomy with decortication. The type and extent of surgery are currently controversially discussed. Within multimodal therapy concepts including cytoreductive surgery, long-term remission is possible in selected patients. When choosing the appropriate surgical therapy the high incidence of recurrence has to be borne in mind.

Chirurgische Therapie des malignen Pleuramesothelioms

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring disease is expected to reach a peak in the coming 5 years. An R0 resection for MPM is technically impossible; therefore, the aim of surgical procedures is to achieve the maximum amount of cytoreduction. There are two established surgical techniques for treatment of MPM, extrapleural pneumonectomy and tumor pleurectomy with decortication. The type and extent of surgery are currently controversially discussed. Within multimodal therapy concepts including cytoreductive surgery, long-term remission is possible in selected patients. When choosing the appropriate surgical therapy the high incidence of recurrence has to be borne in mind.

Chirurgische Therapie des malignen Pleuramesothelioms@@@Surgical therapy of malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring disease is expected to reach a peak in the coming 5 years. An R0 resection for MPM is technically impossible; therefore, the aim of surgical procedures is to achieve the maximum amount of cytoreduction. There are two established surgical techniques for treatment of MPM, extrapleural pneumonectomy and tumor pleurectomy with decortication. The type and extent of surgery are currently controversially discussed. Within multimodal therapy concepts including cytoreductive surgery, long-term remission is possible in selected patients. When choosing the appropriate surgical therapy the high incidence of recurrence has to be borne in mind.

Intraoperative Blutungen in der Thoraxchirurgie@@@Intraoperative bleeding during thoracic surgery: Vermeidungsstrategien und chirurgische Therapiekonzepte@@@Avoidance strategies and surgical treatment concepts

ZusammenfassungHintergrundAnatomisch bedingt sind bei fast allen thoraxchirurgischen Operationen schwere Blutungskomplikationen möglich, besonders bei zentralen Resektionen.ZielZiel des Beitrages ist die Darstellung der Inzidenz der intraoperativen Blutung einschließlich ihrer Vermeidungsstrategien und ihrer chirurgischen Handhabung sowie der anatomischen Besonderheiten der A. pulmonalis.Material und MethodikMittels Literaturrecherche in PubMed, Medline und manueller Recherche wurden Publikationen der letzten 60 Jahre analysiert.ErgebnisseEs liegen wenige Daten zur intraoperativen Blutungshäufigkeit vor. Sie wurden meist retrospektiv gewonnen. Für Mediastinoskopien beträgt die Häufigkeit einer schweren Blutung 0,2 %, für minimal-invasive anatomische Eingriffe beträgt sie im Allgemeinen 4,7 % und in der offenen Chirurgie 5 %. Blutungen aus der zentralen Pulmonalarterie können dramatisch verlaufen und bedürfen einer raschen Reaktion und zielgerichteten Therapie.DiskussionDie Kenntnisse der topographischen Anatomie, der Aufbau, der Verlauf und die Besonderheiten der Lungengefäße sind essenziell, um Blutungskomplikationen zu vermeiden und zu beherrschen. Zu den Vermeidungsstrategien gehören die Techniken der proximalen und distalen Gefäßkontrolle, die Fähigkeiten der intraperikardialen Präparation und der scharfen Präparation. Die Komplikation durch strategisch vorausschauendes Operieren zu vermeiden bzw. durch eine „exit strategy“ beherrschen zu können, muss ein Ziel der thoraxchirurgischen Ausbildung sein.AbsractBackgroundAs a direct result of the thoracic anatomy, heavy bleeding is possible during nearly all central resections in thoracic surgery.ObjectiveDescription of the incidence of intraoperative bleeding including avoidance strategies and treatment concepts. Presentation of special anatomical features of pulmonary arteries.Material and methodsA literature search was performed in Pubmed, medline and by manual searching. Publications from the last 60 years were analyzed and the results are summarized in a structured review.ResultsLittle data is available on the incidence of intraoperative bleeding during thoracic surgery. Most data were collected retrospectively. For mediastinoscopy the incidence of severe bleeding is 0.2 %, for minimally invasive anatomical resections the incidence of intraoperative bleeding is 4.7 % and for open surgery 5 %. Bleeding from the central pulmonary artery can take a dramatic course and requires rapid and targeted therapy.DiscussionKnowledge of the anatomical topographic details, the structure, the course and the specific features of the vessels of the lungs is essential to prevent and treat bleeding. Avoidance strategies include techniques of proximal and distal vessel control, intrapericardial preparation and sharp preparation in general. Techniques of forward-looking preparation and well-prepared exit strategies in case of bleeding have to be part of the training in thoracic surgery.ABSRACT BACKGROUND As a direct result of the thoracic anatomy, heavy bleeding is possible during nearly all central resections in thoracic surgery. OBJECTIVE Description of the incidence of intraoperative bleeding including avoidance strategies and treatment concepts. Presentation of special anatomical features of pulmonary arteries. MATERIAL AND METHODS A literature search was performed in Pubmed, medline and by manual searching. Publications from the last 60 years were analyzed and the results are summarized in a structured review. RESULTS Little data is available on the incidence of intraoperative bleeding during thoracic surgery. Most data were collected retrospectively. For mediastinoscopy the incidence of severe bleeding is 0.2 %, for minimally invasive anatomical resections the incidence of intraoperative bleeding is 4.7 % and for open surgery 5 %. Bleeding from the central pulmonary artery can take a dramatic course and requires rapid and targeted therapy. DISCUSSION Knowledge of the anatomical topographic details, the structure, the course and the specific features of the vessels of the lungs is essential to prevent and treat bleeding. Avoidance strategies include techniques of proximal and distal vessel control, intrapericardial preparation and sharp preparation in general. Techniques of forward-looking preparation and well-prepared exit strategies in case of bleeding have to be part of the training in thoracic surgery.