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Tumoren des unteren Gastrointestinaltrakts

Indikation und Ausmaß der Lymphknotendissektion

Tumors of the lower gastrointestinal tract

Indication and extent of lymph node dissection

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Zusammenfassung

Die Indikation zur Lymphknotendissektion ist bei der Behandlung fortgeschrittener kolorektaler Karzinome in kurativer Intention fast immer gegeben. Allein für ein adäquates Staging sollten mindestens 12 regionäre Lymphknoten untersucht werden. Das Ausmaß und die Qualität der Lymphknotendissektion haben einen erheblichen Einfluss auf die Langzeitprognose der Patienten, sowohl hinsichtlich lokoregionärer Rezidive als auch bezüglich des Langzeitüberlebens. Das Ausmaß der Lymphknotendissektion hängt grundsätzlich vom Verlauf der vom tumortragenden Darmabschnitt nach zentral ziehenden Gefäßarkaden ab und bestimmt das Resektionsausmaß. Weitere wichtige Prinzipien sind die zentrale Unterbindung der versorgenden Gefäße an den Stammgefäßen, die Erhaltung der autonomen Nerven am Stamm der A. mesenterica superior und der Aorta sowie die Bewahrung der Integrität des Mesokolons bzw. Mesorektums. Die Anzahl der untersuchten und der befallenen regionären Lymphknoten hat einen wesentlichen Einfluss auf die Prognose. Auch bei Dünndarmkarzinomen und den meisten neuroendokrinen Tumoren/Karzinomen wird eine systematische Lymphknotendissektion empfohlen. Bei den gastrointestinalen Stromatumoren ist sie meistens unnötig.

Abstract

Lymph node dissection is almost always indicated in the treatment of advanced colorectal carcinoma with curative intent. Investigation of at least 12 regional lymph nodes is required for adequate staging. The extent and quality of lymph node dissection influence the long-term prognosis, especially locoregional recurrences and long-term survival. The extent of lymphadenectomy depends on the tumour site and the pattern of potential lymphatic spread following the course of the blood vessels supplying the tumour. Important principles are central ligation of the supplying arteries and draining veins right at their roots, preservation of autonomous nerves at the trunk of the superior mesenteric artery and the aorta and preservation of the integrity of the mesocolon or mesorectum. The number of regional lymph nodes examined as well as the number of lymph nodes with metastases influence the prognosis. Systematic lymph node dissection is also recommended for carcinomas of the small bowel and in most neuroendocrine tumours or carcinomas but is not required for gastro-intestinal stromal tumours.

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

    S. Merkel, K. Weber, A. Perrakis, J. Göhl &  W. Hohenberger

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  1. S. Merkel
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  2. K. Weber
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  3. A. Perrakis
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  4. J. Göhl
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Correspondence to W. Hohenberger.

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Merkel, S., Weber, K., Perrakis, A. et al. Tumoren des unteren Gastrointestinaltrakts. Chirurg 81, 117–126 (2010). https://doi.org/10.1007/s00104-009-1814-9

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