Organerhaltende Chirurgie des Nierenzellkarzinoms - Operationstechniken und Befunde in der
radiologischen Nachsorge

 

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Zusammenfassung

Die Nachuntersuchungen der in den 70er und 80er Jahren des vergangenen Jahrhunderts organerhaltend operierten Patienten mit beidseitigen Nierenzellkarzinomen oder eingeschränkter Nierenfunktion der Gegenseite (imperative Indikation) zeigten eine sehr niedrige Rezidivrate. Heute wird die organerhaltende Operation von Nierentumoren zunehmend auch bei den Patienten in Erwägung gezogen, deren Nierenfunktion nach der Tumornephrektomie der betroffenen Niere noch ausreichen würde (elektive Indikation). Spezielle Operationstechniken wie die Verwendung von Tabotamp® zur Blutstillung und die Bildung von Pseudotumoren erschweren die Interpretation der Befunde. Für die Nachsorge nach organerhaltender Operation existiert bisher kein Standard. Der Umfang der radiologischen Nachsorge an den unterschiedlichen Institutionen reicht von Kontrollsonographien einmal im Jahr bis hin zu vierteljährlicher Magnetresonanztomographie (MRT). Die Computertomographie (CT) wird, neben dem Ultraschall, als Standardmethode für die Nachsorge nach Resektion angesehen. Die MRT eröffnet durch die multiplanare Darstellung und ihren besseren Weichteilkontrast eine gleichwertige Diagnostik. Gleichzeitig erscheint die MRT für die Patienten mit Einzelniere und eingeschränkter Nierenfunktion überlegen. Die folgende Übersichtsarbeit soll die gängigen Operationstechniken und die damit verbundenen postoperativen Befunde in der Bildgebung von CT, MRT und Sonographie vermitteln.

Abstract

Nephron-sparing surgery of renal cell carcinoma in the 1970's and 1980's in patients with bilateral renal tumors or reduced renal function (imperative indication) has shown a very low risk of recurrent cancer. Today, nephron-sparing surgery in renal cell carcinoma is considered in an increasing number of patients with expected sufficient renal function after nephrectomy (elective indication). Resection technique, the use of Tabotamp® to reduce bleeding, and pseudotumors do complicate the interpretation of the images. It has been not yet defined which diagnostic modality is best suited for follow-up after renal cell carcinoma resection. Follow-up protocols in different institutions show a wide variety. The follow-up of patients after nephron-sparing surgery is performed by annual sonography or MRI every three months. Up to now, CT and ultrasound are the standard methods. MRI with its multiplanar imaging and improved soft tissue contrast seems to have an equal diagnostic value. Additionally, MRI seems to be suited for patients with reduced renal function. The aim of this paper is to give guidelines for the radiologist to understand the different surgical procedures and to evaluate the postoperative findings. Different imaging modalities in the follow-up of patients and special radiological phenomena are discussed.

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Dr. P. Hallscheidt

Abteilung Radiodiagnostik der Radiologischen Klinik
Universitätsklinikum Heidelberg

Im Neuenheimer Feld 110

69120 Heidelberg