Skip to main content
main-content
Erschienen in: Die Chirurgie 6/2019

22.05.2019 | Tumorchirurgie | CME

Lymphadenektomie in der onkologischen Viszeralchirurgie – Teil 2

Karzinome des oberen und unteren Intestinaltraktes

verfasst von: D. W. Kauff, B. Babic, P. P. Grimminger, W. Kneist, MA, FACS Univ.-Prof. Dr. H. Lang

Erschienen in: Die Chirurgie | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Zusammenfassung

Bei Karzinomen des Intestinaltraktes ist das lymphogene Metastasierungsrisiko abhängig von der Histologie, dem Grading und der Infiltrationstiefe (T-Kategorie). Dem prätherapeutischen Staging kommt besondere Bedeutung zu, sowohl hinsichtlich des operativen Vorgehens (lokale Exzision vs. En-bloc Resektion mit regionärer Lymphadenektomie) als auch hinsichtlich einer möglichen neoadjuvanten Therapie. Während sich der erste Teil zur „Lymphadenektomie in der onkologischen Viszeralchirurgie“ den hepatobiliopankreatischen (HPB-)Tumoren widmet, gibt der hier vorliegende zweite Teil einen Überblick über die anatomischen Gegebenheiten des Lymphabflusses von Ösophagus, Magen, Duodenum, Dünndarm, Kolon, Rektum und Anus. Darauf aufbauend werden die Prinzipien und Techniken der Lymphadenektomie bei Karzinomen dieser Organe erläutert und die Anforderungen an die systematische regionäre Lymphadenektomie in der zurzeit gültigen TNM-Klassifikation (8. Auflage) dargestellt.
Literatur
2.
Zurück zum Zitat Holscher AH, Bollschweiler E, Schroder W, Metzger R, Gutschow C, Drebber U (2011) Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg 254(5):802–807 (discussion 7–8) CrossRef Holscher AH, Bollschweiler E, Schroder W, Metzger R, Gutschow C, Drebber U (2011) Prognostic impact of upper, middle, and lower third mucosal or submucosal infiltration in early esophageal cancer. Ann Surg 254(5):802–807 (discussion 7–8) CrossRef
3.
Zurück zum Zitat Heger P, Blank S, Goossen K, Nienhuser H, Diener MK, Ulrich A et al (2019) Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction—a systematic review and meta-analysis. Langenbecks Arch Surg 404(1):103–113 CrossRef Heger P, Blank S, Goossen K, Nienhuser H, Diener MK, Ulrich A et al (2019) Thoracoabdominal versus transhiatal surgical approaches for adenocarcinoma of the esophagogastric junction—a systematic review and meta-analysis. Langenbecks Arch Surg 404(1):103–113 CrossRef
4.
Zurück zum Zitat Holscher AH, Drebber U, Monig SP, Schulte C, Vallbohmer D, Bollschweiler E (2009) Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg 250(5):791–797 CrossRef Holscher AH, Drebber U, Monig SP, Schulte C, Vallbohmer D, Bollschweiler E (2009) Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg 250(5):791–797 CrossRef
5.
Zurück zum Zitat Cancer JRSf G (1973) The general rules for The gastric cancer study in surgery. Jpn J Surg 3(1):61–71 CrossRef Cancer JRSf G (1973) The general rules for The gastric cancer study in surgery. Jpn J Surg 3(1):61–71 CrossRef
6.
Zurück zum Zitat Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T et al (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3(4):219–225 CrossRef Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T et al (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3(4):219–225 CrossRef
7.
Zurück zum Zitat Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T (1989) Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 210(5):596–602 CrossRef Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T (1989) Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 210(5):596–602 CrossRef
8.
Zurück zum Zitat Hoeppner J, Lordick F, Brunner T, Glatz T, Bronsert P, Rothling N et al (2016) ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer 16:503 CrossRef Hoeppner J, Lordick F, Brunner T, Glatz T, Bronsert P, Rothling N et al (2016) ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer 16:503 CrossRef
9.
Zurück zum Zitat Lutz MP, Zalcberg JR, Ducreux M, Adenis A, Allum W, Aust D et al (2019) The 4th St. Gallen EORTC Gastrointestinal Cancer Conference: controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma. Eur J Cancer 112:1–8 CrossRef Lutz MP, Zalcberg JR, Ducreux M, Adenis A, Allum W, Aust D et al (2019) The 4th St. Gallen EORTC Gastrointestinal Cancer Conference: controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma. Eur J Cancer 112:1–8 CrossRef
10.
Zurück zum Zitat Blank S, Schmidt T, Heger P, Strowitzki MJ, Sisic L, Heger U et al (2018) Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer 21(2):303–314 CrossRef Blank S, Schmidt T, Heger P, Strowitzki MJ, Sisic L, Heger U et al (2018) Surgical strategies in true adenocarcinoma of the esophagogastric junction (AEG II): thoracoabdominal or abdominal approach? Gastric Cancer 21(2):303–314 CrossRef
11.
Zurück zum Zitat Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D et al (2016) Gastric cancer: current status of lymph node dissection. World J Gastroenterol 22(10):2875–2893 CrossRef Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D et al (2016) Gastric cancer: current status of lymph node dissection. World J Gastroenterol 22(10):2875–2893 CrossRef
12.
Zurück zum Zitat Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A et al (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359(5):453–462 CrossRef Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A et al (2008) D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359(5):453–462 CrossRef
13.
Zurück zum Zitat Brierley J, Gospodarowicz M, Wittekind C, International Union against Cancer (Hrsg) (2017) TNM Classification of Malignant Tumours, 8. Aufl. John Wiley & Sons, Chichester, Hoboken Brierley J, Gospodarowicz M, Wittekind C, International Union against Cancer (Hrsg) (2017) TNM Classification of Malignant Tumours, 8. Aufl. John Wiley & Sons, Chichester, Hoboken
14.
Zurück zum Zitat de Bree E, Rovers KP, Stamatiou D, Souglakos J, Michelakis D, de Hingh IH (2018) The evolving management of small bowel adenocarcinoma. Acta Oncol 57(6):712–722 CrossRef de Bree E, Rovers KP, Stamatiou D, Souglakos J, Michelakis D, de Hingh IH (2018) The evolving management of small bowel adenocarcinoma. Acta Oncol 57(6):712–722 CrossRef
15.
Zurück zum Zitat Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38(7):705–711 CrossRef Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38(7):705–711 CrossRef
16.
Zurück zum Zitat Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J (2011) Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 98(8):1171–1178 CrossRef Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J (2011) Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 98(8):1171–1178 CrossRef
17.
Zurück zum Zitat Bertelsen CA, Kirkegaard-Klitbo A, Nielsen M, Leotta SM, Daisuke F, Gogenur I (2016) Pattern of colon cancer lymph node metastases in patients undergoing central mesocolic lymph node excision: a systematic review. Dis Colon Rectum 59(12):1209–1221 CrossRef Bertelsen CA, Kirkegaard-Klitbo A, Nielsen M, Leotta SM, Daisuke F, Gogenur I (2016) Pattern of colon cancer lymph node metastases in patients undergoing central mesocolic lymph node excision: a systematic review. Dis Colon Rectum 59(12):1209–1221 CrossRef
18.
Zurück zum Zitat Liang JT, Lai HS, Huang J, Sun CT (2015) Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes. Surg Endosc 29(8):2394–2401 CrossRef Liang JT, Lai HS, Huang J, Sun CT (2015) Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes. Surg Endosc 29(8):2394–2401 CrossRef
19.
Zurück zum Zitat Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Jepsen LV, Kristensen B et al (2014) Lymph node metastases in the gastrocolic ligament in patients with colon cancer. Dis Colon Rectum 57(7):839–845 CrossRef Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Jepsen LV, Kristensen B et al (2014) Lymph node metastases in the gastrocolic ligament in patients with colon cancer. Dis Colon Rectum 57(7):839–845 CrossRef
20.
Zurück zum Zitat Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11(4):354–364 (discussion 64–5) CrossRef Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11(4):354–364 (discussion 64–5) CrossRef
21.
Zurück zum Zitat Strey CW, Wullstein C, Adamina M, Agha A, Aselmann H, Becker T et al (2018) Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept. Surg Endosc 32(12):5021–5030 CrossRef Strey CW, Wullstein C, Adamina M, Agha A, Aselmann H, Becker T et al (2018) Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept. Surg Endosc 32(12):5021–5030 CrossRef
22.
Zurück zum Zitat Lopez-Kostner F, Lavery IC, Hool GR, Rybicki LA, Fazio VW (1998) Total mesorectal excision is not necessary for cancers of the upper rectum. Surgery 124(4):612–617 (discussion 7–8) CrossRef Lopez-Kostner F, Lavery IC, Hool GR, Rybicki LA, Fazio VW (1998) Total mesorectal excision is not necessary for cancers of the upper rectum. Surgery 124(4):612–617 (discussion 7–8) CrossRef
23.
Zurück zum Zitat Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49(11):1663–1672 CrossRef Sugihara K, Kobayashi H, Kato T, Mori T, Mochizuki H, Kameoka S et al (2006) Indication and benefit of pelvic sidewall dissection for rectal cancer. Dis Colon Rectum 49(11):1663–1672 CrossRef
25.
Zurück zum Zitat Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K et al (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, Noninferiority trial. Ann Surg 266(2):201–207 CrossRef Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K et al (2017) Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, Noninferiority trial. Ann Surg 266(2):201–207 CrossRef
26.
Zurück zum Zitat Boman BM, Moertel CG, O’Connell MJ, Scott M, Weiland LH, Beart RW et al (1984) Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 54(1):114–125 CrossRef Boman BM, Moertel CG, O’Connell MJ, Scott M, Weiland LH, Beart RW et al (1984) Carcinoma of the anal canal. A clinical and pathologic study of 188 cases. Cancer 54(1):114–125 CrossRef
Metadaten
Titel
Lymphadenektomie in der onkologischen Viszeralchirurgie – Teil 2
Karzinome des oberen und unteren Intestinaltraktes
verfasst von
D. W. Kauff
B. Babic
P. P. Grimminger
W. Kneist
MA, FACS Univ.-Prof. Dr. H. Lang
Publikationsdatum
22.05.2019