Erweiterte Lymphadenektomie bei rechtsseitigem Kolonkarzinom – eine Übersichtsarbeit

Zusammenfassung

Der onkologische Standard zur kurativen Behandlung des nicht fernmetastasierten Kolonkarzinoms ist die chirurgische Resektion im Sinne einer onkologischen Hemikolektomie rechts mit systematischer Lymphadenektomie. Die lange Zeit als Standard geltende D2-Lymphadenektomie beim rechtsseitigen Kolonkarzinom wurde durch die Einführung der kompletten mesokolischen Exzision (CME) durch Hohenberger et al. 2009 infrage gestellt. Seit diesem Zeitpunkt gab es immer wieder kontroverse Diskussionen über die onkologische Wertigkeit der CME und einer mutmaßlich erhöhten intraoperativen vaskulären Komplikationsrate. Durch randomisiert-kontrollierte multizentrische Studien konnte die Evidenzlage zur CME deutlich verbessert werden, wobei der initial angenommene onkologische Mehrwert nicht mehr so eindeutig nachzuvollziehen ist. Eine erhöhte intraoperative Komplikationsrate konnte jedoch widerlegt werden.

Abstract

Surgical resection with systematic lymphadenectomy remains the standard of care for non-metastasised colon cancer. After the article of Hohenberger et al. in 2009 describing the surgical technique of complete mesocolic excision (CME), D2 lymphadenectomy has been called into doubt after the finding of a better oncological outcome. However, there has been also a controversial discussion about the oncological value of CME, since intraoperative complications may increase. Additional evidence has been provided in recent years from randomised controlled multicentre studies showing that the reported improved oncological long-term outcome after CME is more than questionable. The reported increased rate of intraoperative (vascular) complications could be not confirmed.

Schlüsselwörter

Lymphadenektomie - komplette mesokolische Exzision - Kolonkarzinom - CME - D3-Lymphadenektomie

Keywords

lymphadenectomy - D3 lymphadenectomy - colon cancer - CME - complete mesocolic excision

Publication History

Received: 09 December 2024

Accepted: 06 February 2025

Article published online:
08 April 2025

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