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Lymphadenektomie der Leisten- und Beckenregion

Lymphadenectomy of the inguinal region and pelvis

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Zusammenfassung

Die drainierenden Lymphknotenstationen extraabdomineller maligner Tumoren der unteren Körperhälfte finden sich inguinal und entlang der externen Iliakalgefäße. Eine Notwendigkeit zur operativen Intervention ergibt sich bei der onkologisch-chirurgischen Therapie von Tumoren mit dominantem lymphatischem Abfluss aus dem Anorektum, Genitale, Hauttumoren, Weichteilmalignomen der unteren Abdominalregion und unteren Extremität oder bei primären Lymphknotenerkrankungen. Die aktuellen Erkenntnisse über die Biologie der Malignome, deren Metastasierungwege und die Möglichkeiten der Markierung mittels des Sentinel-Verfahrens, vor allem beim malignen Melanom, haben die Strategie der Lymphknotenchirurgie in den letzten Jahren maßgeblich beeinflusst und die radikale Lymphadenektomie zugunsten einer differenzierten Lymphadenektomie abhängig vom Tumortyp in den Hintergrund treten lassen. Eine Indikation zur Lymphadenektomie ergibt sich heute daher entweder in Form einer alleinigen diagnostischen Lymphknotenentfernung ohne klinischen Befund (Sentinel), mit klinischem Befund oder als regelhafte therapeutische Lymphadenektomie. Als weitere Indikation gilt die Lymphadenektomie im Rahmen palliativer Eingriffe. Der Schonung der Lymphabflusswege und Reduktion von Wundheilungsstörungen wird zunehmend Bedeutung zugemessen.

In diesem Beitrag sollen der aktuelle Stand der Differentialindikation, technischen Durchführung und die dabei zu berücksichtigenden prognostischen Überlegungen für die Lymphadenektomie der Inguinal- und Beckenregion dargestellt werden.

Abstract

The draining lymph nodes of extra-abdominal tumors and malignant lesions of the lower extremity are located in the groin and iliac region. Malignancies with lymphatic drainage into this region include tumors of the anorectum, penis and vulva, skin (melanoma, squamous cell carcinoma), and soft tissue sarcomas. Current clinical research in biology, routes of lymphatic spread, and the possibility of marking the sentinel lymph node has directed lymphadenectomy strategy toward differential procedures, depending on the type of underlying malignancy. The spectrum of lymphadenectomy includes diagnostic lymph node removal of clinically enlarged nodes, removal of the sentinel node, and radical lymphadenectomy. Lymphadenectomy can also be indicated as a palliative procedure. The indications also depend on the type of tumor, previous treatment, and disease prognosis. This review presents the current state of indications and surgical techniques of inguinal and iliacal lymphadenectomy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule, Carl-Neuberg-Straße 1, 30625 , Hannover , Deutschland

    P.M. Vogt, L.-W. Lahoda, M. Meyer-Marcotty, M. Spies & K.H. Busch

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  1. P.M. Vogt
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  2. L.-W. Lahoda
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  3. M. Meyer-Marcotty
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  4. M. Spies
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  5. K.H. Busch
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Correspondence to P.M. Vogt.

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Vogt, P., Lahoda, LW., Meyer-Marcotty, M. et al. Lymphadenektomie der Leisten- und Beckenregion. Chirurg 78, 226–235 (2007). https://doi.org/10.1007/s00104-006-1298-9

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