Zusammenfassung
Die Lymphadenektomie (LAE) wird beim Kolonkarzinom aus diagnostischen Erwägungen heraus,
möglicherweise auch zur Prognoseverbesserung durchgeführt. Es wäre sinnvoll, die feingewebliche
Untersuchung auf wenige, repräsentative Lymphknoten zu beschränken und eine LAE befundadaptiert
durchzuführen. Dies sind die wesentlichen Ziele der Sentinel Node (SLN) Biopsie. Trotz
erheblicher Unsicherheiten bez. der idealen Untersuchungstechnik zeigt die noch limitierte
Erfahrung im Schrifttum an, dass die grundsätzliche Richtigkeit des SLN-Konzeptes
auch beim Kolonkarzinom besteht. Der SLN scheint in hohem Maße identifizierbar, kann
den Nodalstatus des Lymphknoten-Kompartimentes verlässlich vorhersagen, mag zum „upstaging”
von-Dukes B-Karzinomen beitragen und könnte in Zukunft für die Entscheidung zur erweiterten
LAE von Belang sein. Ob ein Verzicht auf eine LAE bei nodal-negativen Patienten sinnvoll
sein könnte, ist zurzeit unklar.
Abstract
In colon cancer patients, lymphadenectomy is carried out for diagnostic reasons, possibly
also to improve outcome. The chief goals of sentinel node biopsy are to reduce histological
investigation to one or few representative lymph nodes and to confine systematic lymphadenectomy
to patients with lymphatic metastasis. Despite considerable uncertainty concerning
the ideal technique, recently published data indicate that SLN biopsy is feasible
also in colon cancer. The SLN can be identified with a high success rate, may predict
the status of locoreginonal lymphnodes accurately, is likely to upstage some Dukes'
B cancer patients because of micrometastatic disease and could be valid to plan extended
lymphadenectomy in future. To date, it is unclear whether a tailored lymphadenectomy
on the basis of SLN-status could be beneficial to reduce perioperative morbidity.
Schlüsselwörter
Kolonkarzinom - Lymphadenektomie - Sentinel-Node-Biopsie
Key words
Colon cancer - lymphadenectomy - sentinel node biopsy
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Dr. med. O. Horstmann
Klinik für Allgemeinchirurgie, Universitätsklinikum Göttingen
Robert-Koch-Straße
37075 Göttingen
Telefon: 0551/392952
Fax: 0551/396109
eMail: ohorstmann@chirurgie-goettingen.de
