尿路性悪性腫瘍に対するサルベージ手術の適応と転帰

Based on the available data from mostly retrospective clinical studies, the indication for salvage surgery for tumors of the urogenital tract must be very strictly assessed by weighing the oncological benefit and possible therapy-associated complications. All patients should be advised in interdisciplinary tumor boards and the surgical procedure should only be performed by experienced surgeons. In the case of renal cell carcinoma, patients with lung or pancreatic metastases should be advised with regard to salvage surgery due to the favorable long-term results and moderate complication rates. Patients with cerebral metastases are managed via resection in combination with systemic therapy or stereotactic radiotherapy. In the case of urothelial carcinoma of the urinary bladder, only patients with minimal lymph node metastasis and pulmonary oligometastasis that persist stably after systemic therapy seem to benefit. For local recurrence of prostate cancer after radiotherapy, salvage prostatectomy is associated with a tumor-specific survival of over 80% in the case of localized tumor, lack of lymph node metastases, and long prostate-specific antigen (PSA) doubling time. Preoperatively, multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron-emission tomography/computed tomography (PSMA-PET/CT) are indispensable. Salvage lymphadenectomy for pelvic oligometastases should only be performed if risk factors are favorable. Cure is achieved in very few patients. The primary goal is to extend the time without antihormonal therapy, which can be up to 41 months. In the case of testicular germ cell tumors, salvage operations have a curative character and are only to be performed in designated centers in accordance with guidelines.