Dokument

Zusammenfassung:
Fragestellung: In zahlreichen Studien wurden Prognosefaktoren für das Auftreten von Lokalrezidiven untersucht und identifiziert. Einer der wichtigsten ist der Resektionskantenstatus. Weitaus seltener untersucht sind patientenbezogene und tumorbiologische Faktoren die das Risiko einer insuffizienten chirurgischen Primärtherapie erhöhen. Die vorliegende Arbeit hat sich ausschließlich der Untersuchung dieser Einflussfaktoren gewidmet. Patientinnen und Methoden: Das Patientenkollektiv in der vorliegenden Arbeit setzt sich zusammen aus 227 Patientinnen, die im Jahr 2006, aufgrund eines invasiv duktalen (IDC) oder invasiv lobulären Mammakarzinoms (ILC) im Universitätsklinikum Marburg operiert wurden. Im Rahmen einer retrospektiven Kohortenstudie wurden 26 patientenbezogene oder tumorbiologische Parameter mithilfe univariater und multivariater Testungen untersucht. Ergebnisse: Von den 227 Frauen des Studienkollektivs mussten 19,4% aufgrund von positiven Resektionskanten mindesten ein zweites Mal operiert werden. Mehr als ein Drittel (36,4%) dieser Patientinnen wiesen dabei kein invasives, sondern ausschließlich ein in situ Karzinom in den Schnittkanten auf. Faktoren die sich in der vorliegenden Studie in der abschließend multivariaten Testung als unabhängig einflussnehmend auf den Resektionskantenstatus herausstellten waren die Tumorgröße (p = 0,003), die Länge des Exzidats (p = 0,045), das Vorliegen eines DCIS (p = 0,001) und die primäre Operationstechnik (p = 0,001). Schlussfolgerung: Insgesamt bestätigen die Ergebnisse dieser Arbeit die Datenlage internationaler Studien. Bei Vorliegen eines DCIS-Anteils des Tumors und bei Tumoren die einen Durchmesser von 5 cm überschreiten sollte die Exzision des pathologischen Gewebes im Vorhinein großzügiger geplant werden. Da die Raten insuffizienter Primäroperationen bei Mastektomien signifikant niedriger waren, sollte immer eine besonders präzise Abschätzung des Risiko-Nutzen Werts einer brusterhaltenden Therapie erfolgen. Die Annahme dass invasiv lobuläre Karzinome, aufgrund ihres häufig dissoziierten Wachstums, häufiger primär unzureichend reseziert werden, konnte nicht bestätigt werden. Eine Erklärung hierfür könnte die gute präoperative Diagnostik mit entsprechender chirurgischer Therapieplanung sein.

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