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Lymphknotendissektion bei Karzinomen des unteren Gastrointestinaltraktes

Was ist evidenzbasiert?

Lymph node dissection for carcinomas of the lower gastrointestinal tract

What is evidence-based?

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Zusammenfassung

Die Beurteilung der Evidenzlage zur Notwendigkeit einer Lymphknotendissektion bei der Behandlung kolorektaler Karzinome wird durch die inzwischen etablierten multimodalen Behandlungsverfahren erschwert. Zusätzlich bestimmen weitere operative Qualitätskriterien wie eine exakte Präparation entlang den mesenterialen Faszien unter Vermeidung von Einrissen die Prognose.

Die Evidenzlage für die grundsätzliche Notwendigkeit der Lymphknotendissektion bei der Behandlung kolorektaler Karzinome ist – mit Abstufungen zu den vielfältigen Detailfragen – hoch. Jedoch verbleiben mehrere offene Fragen, vor allem zum Ausmaß der perikolischen Dissektion und der Einbeziehung der Lymphknoten entlang der A. gastroepiploica dextra und am Unterrand des Pankreas bei Karzinomen des Colon transversum und der Flexuren. Vor allem die tatsächliche zentrale Unterbindung der versorgenden Arterien wird offensichtlich bei Karzinomen des rechten Kolons derzeit weltweit noch nicht adäquat umgesetzt.

Abstract

Evidence-based analysis of the influence of lymph node dissection on the prognosis of colorectal cancer patients is complicated by the now well-established multimodal treatment strategies. In addition surgical quality criteria, such as exact preparation along the mesenterial fascia and avoiding tears have a major influence on the prognosis.

Nevertheless, the overall evidence for the need of lymph node dissection in the treatment of colorectal carcinoma is high. However, there are still some questions remaining concerning the extent of pericolic lymph node dissection, inclusion of the lymph nodes along the greater curvature of the stomach and the inferior aspect of the left pancreas in carcinomas of the transverse colon and the flexures. In particular the definitive central ligation of the supplying arteries in right-sided colon carcinoma is not adequately implemented worldwide.

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

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

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

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Hohenberger, W., Lux, P., Merkel, S. et al. Lymphknotendissektion bei Karzinomen des unteren Gastrointestinaltraktes. Chirurg 82, 1096–1105 (2011). https://doi.org/10.1007/s00104-011-2117-5

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