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Lymphadenektomie bei Tumoren des unteren Gastrointestinaltraktes

Lymphadenectomy with tumors of the lower gastrointestinal tract

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Zusammenfassung

Für die meisten fortgeschrittenen Adenokarzinome des unteren Gastrointestinaltraktes ist inzwischen das Konzept der radikalen Lymphknotendissektion ohne Einschränkung akzeptiert. Die Qualität der Lymphadenektomie beeinflusst zudem die Prognose. Dies ist inzwischen für das Kolonkarzinom bewiesen. In diesem Beitrag wird die Technik und das Ausmaß der Lymphknotendissektion beschrieben, welche in der eigenen Klinik in den letzten zwei Jahrzehnten durch systematische Untersuchungen zur lymphogenen Metastasierung wie auch Analyse von Langzeitüberlebensdaten und Lokalrezidivraten kontinuierlich weiterentwickelt wurde.

Zwei wichtige Schritte werden im Detail beschrieben: zunächst die komplette Mobilisierung von Kolon mit Mesenterialwurzel einschließlich Einschluss der folgenden mesokolischen Exzision mit Erhalt der viszeralen Faszie. Ein weiterer wichtiger Schritt ist die sich dann anschließende zentrale Unterbindung der vom Tumor befallenen Kolongefäße. Sie hat entscheidenden prognostischen Einfluss.

Unter Befolgung dieser Regeln wurden in der eigenen Klinik ohne adjuvante systemische Behandlung inzwischen 5-Jahres-Überlebensraten im UICC-Stadium III für Kolonkarzinome von über 80% erreicht.

Abstract

For advanced adenocarcinomas, which are the most frequent tumours of the lower GI tract, the concept of radical lymphnode dissection is well accepted. The quality of lymphadenectomy for these malignancies has a strong effect on cancer-related survival. Based upon a strict quality control program with outcome evaluated according to internal results, the technique and extent of lymph node dissection have been continously developed over the last three decades. These are described in detail, including instructive pictures to clarify the surgical steps needed. Apart from multivisceral resection in far advanced cases, which still have a chance of cure if adequate guidelines are followed, two additional steps in the so-called radical surgical treatment of these tumours are prerequisites for cure. The first is complete mobilisation of the intestine involving complete mesocolic excision with complete retention of the visceral fascia and covering potential lymph node metastases and extranodal spread on the intestinal side. The second step is the central tying of the tumor’s supplying vessels. Following these rules and with no adjuvant systemic treatment, 5-year survival figures of 80% can be reached, even for UICC stage III disease.

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Literatur

  1. Abrahams NA, Halverson A, Fazio VW et al. (2002) Adenocarcinoma of the small bowel. A study of 37 cases with emphasis on histologic prognostic factors. Dis Colon Rectum 45: 1496–1502

    Article  PubMed  Google Scholar 

  2. Bembenek A, Gretschel S, Ulmer C, Schlag PM (2004) Sentinal lymph node biopsy in colorectal carcinoma. Chirurg 75: 761–766

    Article  PubMed  Google Scholar 

  3. Capella C, Heitz PU, Hofler H et al. (1994) Revised classification of neuroendocrine tumors of the lung, pancreas and gut. Digestion [Suppl 3] 55: 11–23

    Google Scholar 

  4. Dabaja BS, Suki D, Prof B et al. (2004) Adenocarcinoma of the small bowel. Presentation, prognostic factors, and outcome of 217 patients. Cancer 101: 518–526

    Article  PubMed  Google Scholar 

  5. Daum S, Ullrich R, Heise W et al. (2003) Intestinal non-Hodgkin’s lymphoma: a multicenter prospective clinical study from the German Study Group on Intestinal non-Hodgkin’s Lymphoma. 14: 2740–2746

  6. DeMatteo RP, Lewis JJ, Leung D et al. (2000) Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 231: 51–58

    Article  PubMed  Google Scholar 

  7. Dworák O (1989) Number and size of lymph nodes and node metastases in rectal carcinomas. Surg Endosc 3: 96–99

    Article  PubMed  Google Scholar 

  8. Fischbach W (2004) Gastrointestinale Lymphome. Z Gastroenterol 42: 1067–1072

    Article  PubMed  Google Scholar 

  9. Fujita S, Yamamoto S, Akasu T et al. (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. 90: 1580–1585

  10. Gerard JP, Chapet O, Samiei F et al. (2001) Management of inguinal lymph node metastases in patients with carcinoma of the anal canal. Cancer 92: 77–84

    Article  PubMed  Google Scholar 

  11. Giedl J (1986) Lymphknotenmetastasen kolorektaler Karzinome. Häufigkeit und Topographie. Fortschr Med 104: 167–170

    PubMed  Google Scholar 

  12. Grabenbauer GG (2007) Analkarzinom. In: Hiddeman W, Huber H, Bartram CR (Hrsg) Die Onkologie. 2. Aufl. Springer, Berlin, in Vorbereitung

  13. Haselkorn T, Whittemore AS, Lilienfeld DE (2005) Incidence of small bowel cancer in the United States and worldwide: geographic, temporal and racial differences. Cancer Causes Control 16: 781–787

    Article  PubMed  Google Scholar 

  14. Heald RJ (1988) The ‚Holy Plane‘ of rectal surgery. J R Soc Med 81: 503–508

    PubMed  Google Scholar 

  15. Hida J, Yasutomi M, Fuijimoto K et al. (1997) Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method. J Am Coll Surg 184: 475–480

    PubMed  Google Scholar 

  16. Hida J, Yasutomi M, Maruyama T et al. (1997) Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method: justification of total mesorectal excision. J Am Coll Surg 184: 584–588

    PubMed  Google Scholar 

  17. Hohenberger P, Wardelmann E (2006) Gastrointestinale Stromatumoren – Was der Chirurg wissen muss. Chirurg 77: 33–40

    Article  PubMed  Google Scholar 

  18. Hohenberger W, Schick CH, Göhl J (1998) Mesorectal lymph node dissection: is it beneficial? Langenbecks Arch Surg 383: 402–408

    Article  PubMed  Google Scholar 

  19. Hohenberger W, Reingruber B, Merkel S (2003) Surgery for colon cancer. Scand J Surg 92: 45–52

    PubMed  Google Scholar 

  20. Hohenberger W (2007) Offene Rektumchirurgie. Chirurg (im Druck)

  21. Howe JR, Karnell LH, Menck HR, Scott-Conner C (1999) Adenocarcinoma of the small Bowel. Review of the National Cancer Data Base 1985–1995. Cancer 86: 2693–2706

    Article  PubMed  Google Scholar 

  22. Jemal A, Siegel R, Ward E et al. (2006) Cancer Statistics, 2006. CA Cancer J Clin 56: 106–130

    PubMed  Google Scholar 

  23. Jinnai D (1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Jpn J Surg 13: 557–573

    Article  PubMed  Google Scholar 

  24. Klöppel G, Heitz PU, Capella C, Solcia E (1996) Pathology and nomenclature of human gastrointestinal neuroendocrine (carcinoid) tumors and related lesions. World J Surg 20: 132–141

    Article  PubMed  Google Scholar 

  25. Koch P, Valle F del, Berdel WE et al. (2001) Primary gastrointestinal non-Hodgkin’s lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol 19: 3861–3873

    Google Scholar 

  26. Le Voyer TE, Sigurdson ER, Hanlon AL et al. (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21: 2912–2919

    Article  PubMed  Google Scholar 

  27. Lopez-Kostner F, Lavery IC, Hool GR et al. (1998) Total mesorectal excision is not necessary for cancers of the upper rectum. Surgery 124: 612–617

    Article  PubMed  Google Scholar 

  28. Matzel KE, Merkel S, Hohenberger W (2003) Local therapy principles in rectal carcinoma. Chirurg 74: 897–904

    Article  PubMed  Google Scholar 

  29. Modlin IM, Lye KD, Kidd M (2003) A 5-Decade Analysis of 13,715 Carcinoid Tumours. Cancer 97: 934–959

    Article  PubMed  Google Scholar 

  30. Ramage JK, Davies AHG, Ardill J et al. (2005) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut [Suppl IV] 54:1–16

    Google Scholar 

  31. Saha S, Seghal R, Patel M et al. (2006) A multicenter trial of sentinel lymph node mapping in colorectal cancer: prognostic implications of nodal staging and recurrence. Am J Surg 191: 305–310

    Article  PubMed  Google Scholar 

  32. Stelzner F (2005) Embryologie, vergleichende Anatomie und Genetik der Analregion. 13–51. In: Lange J, Mölle B, Girona J (Hrsg) Chirurgische Proktologie. Springer, Heidelberg

  33. Tran T, Davila J, El-Serag H (2005) The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 100: 162–168

    Article  PubMed  Google Scholar 

  34. Veyrières M, Baillet P, Hay JM et al. (1997) Factors influencing long-term survival in 100 cases of small intestine primary adenocarcinoma. Am J Surg 173: 237–239

    Article  PubMed  Google Scholar 

  35. Wu T-J, Yeh C-N, Chao T-C et al. (2006) Prognostic factors of primary small bowel adenocarcinoma: univariate and multivariate analysis. World J Surg 30: 391–398

    Article  PubMed  Google Scholar 

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  1. Chirurgische Klinik, Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    W. Hohenberger, S. Merkel & K. Weber

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

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Hohenberger, W., Merkel, S. & Weber, K. Lymphadenektomie bei Tumoren des unteren Gastrointestinaltraktes. Chirurg 78, 217–225 (2007). https://doi.org/10.1007/s00104-007-1311-y

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