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Prinzip und Technik der Lymphknotendissektion beim kolorektalen Karzinom

Principles and technique of lymph node dissection in colorectal carcinoma

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Zusammenfassung

Das kolorektale Karzinom ist ein häufiger, bösartiger Tumor, der ein regelhaftes lymphogenes Metastasierungsverhalten aufweist. Abhängig von der Lokalisation müssen die jeweiligen Lymphabstromgebiete bei der Operation mit entfernt werden, da bei jedem Tumor bereits Lymphknotenmetastasen vorhanden sein können, auch wenn intraoperativ kein offensichtlicher Befall ersichtlich ist. Der Lymphabfluss orientiert sich im Wesentlichen an den versorgenden Arterien des entsprechenden Darmabschnittes. Die Anatomie der arteriellen Versorgung ist dabei individuell sehr variabel und weicht oft von der gängigen Lehrbuchdarstellung ab.

In unserer Übersichtsarbeit beschreiben wir die onkologischen Erfordernisse einer systematischen Lymphdissektion bei kolorektalen Karzinomen und legen dabei den Schwerpunkt auf die technischen Aspekte, um eine optimale Präparatequalität zu erzielen.

Abstract

Colorectal carcinoma is a common malignant tumor which shows a standard behavior for lymphogenic metastasis. Depending on the localization of the primary tumor the corresponding lymphatic area also has to be removed because lymph node metastases can already be present by every tumor even if there is no obvious intraoperative evidence. Lymphatic drainage is essentially oriented to the supplying arteries of the corresponding intestinal segment. The anatomy of arterial supply is individually variable and often deviates from the usual textbook presentation.

In this review the oncological requirements of an adequate lymph node dissection in colorectal carcinoma are described with emphasis on the technical aspects to obtain an optimal specimen.

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  1. Chirurgische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland

    K. Weber, J. Göhl, P. Lux, S. Merkel &  W. Hohenberger

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  1. K. Weber
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  2. J. Göhl
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  3. P. Lux
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  4. S. Merkel
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  5. W. Hohenberger
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Correspondence to W. Hohenberger.

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Weber, K., Göhl, J., Lux, P. et al. Prinzip und Technik der Lymphknotendissektion beim kolorektalen Karzinom. Chirurg 83, 487–500 (2012). https://doi.org/10.1007/s00104-011-2238-x

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