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Lymphknotenstaging bei Genitalkarzinomen – wohin geht die Reise?

Lymph node staging in genital carcinomas—Where does the journey lead to?

Zusammenfassung

Die lymphogene Metastasierung ist bei genitalen Karzinomen ein wichtiger diagnostischer und prognostischer Parameter. Zunehmend wird aber die therapeutische Bedeutung der operativen Resektion von Lymphknoten diskutiert. Systematische Lymphonodektomien bergen darüber hinaus ein erhebliches Morbiditätsrisiko, weshalb die Indikation jeweils kritisch geprüft werden muss. Zunehmende Bedeutung gewinnt die Sentinel-Node-Biopsie (SNB), die ein Lymphknotenstaging bei geringem Komplikationsrisiko ermöglichen kann. Bei fortgeschrittenen Ovarialkarzinomen und beim Endometriumkarzinom zeigt sich nach aktuellem Kenntnisstand kein Überlebensvorteil nach systematischer Lymphonodektomie und auch die pelvine Lymphonodektomie beim Vulvakarzinom wird kontrovers diskutiert. Die SNB beim Vulva- und Endometriumkarzinom wurde in einer größeren Anzahl von Studien evaluiert und sollte bei entsprechender Indikation in der Klinik eingesetzt werden. Die SNB kann u. U. zudem bei frühen Zervixkarzinomen eingesetzt werden. Beim frühen Ovarialkarzinom werden in den nächsten Jahren Daten zur SNB aus der SELLY-Studie erwartet. Die diagnostische Bedeutung der systematischen Lymphonodektomie beim Zervixkarzinom bleibt derzeit hoch. So erfolgt bei pelvinen Lymphknotenmetastasen anstelle einer radikalen Hysterektomie in der Regel eine primäre Radiochemotherapie. Im folgenden Artikel werden aktuelle Erkenntnisse in Bezug auf Lymphonodektomien bei genitalen Karzinomen dargestellt.

Abstract

Lymphogenic metastasis is an important diagnostic and prognostic parameter of genital carcinomas; however, the therapeutic value of surgical lymph node resection is increasingly being discussed. In addition, systematic lymph node resection has a significant risk of morbidity, which is why the indications should be carefully verified. The importance of sentinel lymph node biopsies (SNB) has been increasing for years as it often enables adequate lymph node staging with a low risk of complications. According to the state of the art, systematic lymph node resection does not improve the survival rates in advanced ovarian cancer and endometrial carcinomas. Systematic pelvic lymph node resection in advanced vulvar neoplasms is also controversially discussed. The SNB in endometrial and vulvar cancers was extensively investigated and should be clinically applied with appropriate indications. In early cervical cancer SNB can also be an adequate treatment option. Within the next years the results of the SELLY study concerning SNB in early ovarian cancers are expected. The diagnostic relevance of systematic lymph node resection in cervical carcinomas currently remains high. In the case of pelvic lymph node metastases, chemoradiotherapy is usually applied instead of radical hysterectomy. This article presents the current state of knowledge concerning lymph node resection in genital carcinomas.

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Correspondence to Louisa Proppe.

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Interessenkonflikt

L. Proppe, A. Rody und L.C. Hanker geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Proppe, L., Rody, A. & Hanker, L.C. Lymphknotenstaging bei Genitalkarzinomen – wohin geht die Reise?. Gynäkologe (2021). https://doi.org/10.1007/s00129-021-04874-6

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Schlüsselwörter

  • Lymphatische Metastasierung
  • Vulväre Neoplasien
  • Sentinellymphknoten-Biopsie
  • Endometriumkarzinome
  • Ovarialkarzinome

Keywords

  • Lymphatic metastasis
  • Vulvar neoplasms
  • Sentinel lymph node biopsy
  • Endometrial neoplasms
  • Ovarian neoplasms