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Mammakarzinom: Axilläre Lymphonodektomie —zu welchem Preis

  • 3. Hauptthema/Troisième thème principal 1. Teil/1ère partie Axilläre Lymphonodektomie
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Zusammenfassung

Auf die axilläre Lymphonodektomie beim invasiven Mammakarzinom kann z.Z. noch nicht verzichtet werden, da der Lymphknotenstatus das beste Prognosekriterium darstellt (prognostischer Wert der Lymphonodektomie). Klinisch nicht befallene Lymphknoten Bind in einem hohen Prozentsatz mikroskopisch befallen und machen eine spätere axilläre Revision in 15–20% der Fälle notwendig, sofern initial darauf verzichtet wird (therapeutischer Effekt der Lymphonodektomie). Die Kenntnis des Lymphknotenstatus ist für die Einleitung einer postoperativen adjuvanten Systemtherapie in der Regel unerläßlich (therapeutische Konsequenz aus der Lymphonodektomie). Deshalb bewirkt die axilläre Lymphonodektomie indirekt auch eine Lebensverlängerung. Ein direkter Effekt auf die Überlebensraten kann jedoch weitgehend ausgeschlossen werden. Bei Insitu-Karzinomen soll keine Axillarevision vorgenommen werden. Dafür sollte bei invasiven Karzinomen die Lymphonodektomie vollständig (Level I und Level II) erfolgen, weil nur so falsch-negative Befunde (Skipping-Phänomen) und axilläre Rezidive weitgehend verhindert werden können. Bei vollständiger Lymphonodektomie kann zudem in der Regel auf eine zusätzliche Radiotherapie verzichtet werden (fehlendes Substrat für die Bestrahlung), wodurch man sich eine Verminderung der Morbidität (Einschränkung der Schultergelenksmobilität und Lymphödeme) verspricht.

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  1. Abteilung für Geburtshilfe und Gynäkologie, Limmattalspital, CH-8952, Schlieren, Switzerland

    J. C. Rageth

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Rageth, J.C. Mammakarzinom: Axilläre Lymphonodektomie —zu welchem Preis. Arch Gynecol Obstet 256 (Suppl 1), S85–S92 (1995). https://doi.org/10.1007/BF02201942

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  • DOI: https://doi.org/10.1007/BF02201942

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