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DOI: 10.1055/s-2000-6905
© Georg Thieme Verlag Stuttgart · New York
Magenkarzinom: Stellenwert der Lymphknotendissektion
Publication History
Publication Date:
31 December 2000 (online)
![](https://www.thieme-connect.de/media/viszeralchirurgie/200004/lookinside/thumbnails/10.1055-s-2000-6905-1.jpg)
Zusammenfassung.
Die komplette intra- und extraluminäre Tumorresektion ist das Ziel der chirurgischen Therapie beim Magenkarzinom. Während die intraluminären Resektionsgrenzen am Magen weitgehend standardisiert werden konnten, wird das Ausmaß und die Bedeutung der Lymphadenektomie, nicht zuletzt auch aufgrund der unterschiedlichen Ergebnisse nichtrandomisierter und randomisierter Studien, weiterhin kontrovers diskutiert. Das operative Risiko der erweiterten D2-Lymphadenektomie wird vor allem durch eine synchrone oder obligat durchgeführte Splenektomie und/oder Pankreaslinksresektion gesteigert. Ein direkter therapeutischer Effekt und eine realistische Prognoseverbesserung nach systematischer Ausräumung der Lymphknoten im Compartment I und II ist vor allem im UICC-Stadium II bzw. bei geringem Ausmaß der Lymphknotenmetastasierung (pN0, 1) zu erreichen. In fortgeschrittenen Tumorstadien kann lediglich eine Verbesserung der lokalen Tumorkontrolle mit Senkung der lokoregionären Rezidive erwartet werden. Eine Einschränkung oder Verzicht der Lymphadenektomie ist bei speziellen Tumorformen des Magenfrühkarzinoms vom Mucosatyp oder bei nicht kurativem Therapieansatz gerechtfertigt. In allen anderen Fällen sollte bei entsprechender operativer Erfahrung die systematische Lymphknotendissektion integrierter Bestandteil der angestrebten kurativen Tumorresektion sein.
Gastric carcinoma: Importance of lymph node dissection.
Complete intra- and extraluminal tumor removal must be the aim of surgical treatment of gastric carcinoma. The intraluminal extent of gastric resection, i. e., subtotal distal or total gastrectomy, could be standardized. In contrast, the value of lymph node dissection is still in discussion caused by the results obtained following randomized studies. Postoperative morbidity and mortality following D2-lymphadenectomy is increased by the performance of obligatory splenectomy and/or resection of the pancreas. Following extended lymph node dissection a positive impact on the survival rate could be obtained above all in stage II-disease or low incidence of lymph nodes metastatic involved. In locally advanced tumor stages exact lymphadenectomy might decrease the rate of locoregional relapse. The performance of limited lymph node dissection seems to be justified in some subgroups of the early gastric cancer or in palliative surgical approaches. In general, systematic D2-lymphadenectomy should be an integrated part of curative resective procedures performed by experienced surgeons or in high volume hospitals.
Schlüsselwörter:
Magenkarzinom - Lymphadenektomie - Postoperative Morbidität und Letalität - Überlebensraten
Key words:
Gastric carcinoma - Lymphadenectomy - Postoperative morbidity and mortality - Survival rates
Literatur
- 1 Hölscher A H, Bollschweiler E. Ausmaß von Resektion und Lymphadenektomie beim Magenkarzinom - eine anhaltende Kontroverse. Onkologie. 1998; 4 301-309
- 2 Jaehne J, Meyer H J, Maschek H, et al. Lymphadenectomy in gastric carcinoma. Arch Surg. 1992; 127 290-294
- 3 Jatzko G R, Lisborg P H, Denk H, et al. A 10-year experience with Japanese-type radical lymph node dissection for gastric cancer outside of Japan. Cancer. 1995; 76 1302-1312
- 4 Meyer H J, Jähne J, Wilke H. Perspectives of surgery and multimodality treatment in gastric carcinoma. J Cancer Res Clin Oncol. 1993; 119 384-394
- 5 Cuschieri A. Surgical treatment of patients with invasive gastric cancer: dogma, debate and data. Eur J Surg Oncol. 1999; 25 205-208
- 6 Roder J D, Bonenkamp J J, Craven M D, et al. Lymphadenectomy for gastric cancer in clinical trials: Update. World J Surg. 1995; 19 546-553
- 7 Viste A, Svanes K, Janssen C W, et al. Prognostic importance of radical lymphadenectomy in curative resections for gastric cancer. Eur J Surg. 1994; 160 497-502
- 8 Kodama Y, Sugimachi K, Soejima K, et al. Evaluation of extensive lymph node dissection for carcinoma of the stomach. World J Surg. 1981; 5 241-248
- 9 Maruyama K, Sasako M, Kinoshita T, et al. Effectiveness of systematic lymph node dissection in gastric cancer surgery. Acta Chir Austriaca. 1995; 27 23-27
- 10 Noguchi M, Miyazaki I. Prognostic significance and surgical management of lymph node metastasis in gastric cancer. Br J Surg. 1996; 83 156-161
- 11 Faß J, Hungs M, Reineke T, et al. Zur Frage der Prognoseverbesserung durch R1- und R2-Lymphadenektomie beim Magenkarzinom. Chirurg. 1994; 65 867-872
- 12 Gall F P, Hermanek P. Die systematisch erweiterte Lymphknotendissektion in der kurativen Therapie des Magenkarzinoms. Chirurg. 1993; 64 1024-1031
- 13 Hiller W FA, Jähne J, Meyer H J. Impact of D2 lymphadenectomy on morbidity and long-term survival in patients with gastric cancer. Onkologie. 1997; 20 145-150
- 14 Jähne J, Maschek H, Meyer H J, et al. Systematische Lymphadenektomie beim Magenkarzinom - Staging und Therapie. Zentralbl Chir. 1996; 121 126-130
- 15 Meyer H J, Jaehne J. Rationale and technique of systematic lymph node dissection in gastric carcinoma. Dig Surg. 1994; 11 72-77
- 16 Pacelli F, Doglietto G B, Bellantone R, et al. Extensive versus limited lymph node dissection for gastric cancer: a comparative study of 320 patients. Br J Surg. 1993; 80 1153-1156
- 17 Siewert J R, Böttcher K, Roder J D, et al. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. Br J Surg. 1993; 80 1015-1018
- 18 Smith J W, Shiu M H, Kelsey L, et al. Morbidity of radical lymphadenectomy in the curative resection of gastric carcinoma. Arch Surg. 1991; 126 1469-1473
- 19 Volpe C M, Koo J, Miloro S M, et al. The effect of extended lymphadenectomy on survival in patients with gastric adenocarcinoma. J Am Coll Surg. 1995; 181 56-64
- 20 Bonenkamp J J, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995; 345 745-748
- 21 Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gatric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet. 1996; 347 995-999
- 22 Sasako M. Risk factors for surgical treatment in the Dutch gastric cancer trial. Br J Surg. 1997; 84 1567-1571
- 23 Weeden S, Cuschieri A, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the UK medical research council (MRC) randomized surgical trial. Proc ASCO. 1998; 17 258a
- 24 Bonenkamp J J, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999; 340 908-914
- 25 Hermanek P. Will-Rogers-Phänomen - Fakt oder Fiktion?. Chirurg. 1996; 67 769-770
- 26 Ishida K, Katsuyama T, Sugiyama A, et al. Immunohistochemical evaluation of lymph node micrometastases from gastric carcinomas. Cancer. 1997; 79 1069-1076
- 27 Kitamura K, Nishida S, Yamamoto K, et al. Poor prognosis in early gastric cancer complicated by five or more positive nodes. Hepato-Gastroenterol. 1998; 45 583-586
- 28 Lee W J, Lee P H, Yue S C, et al. Lymph node metastases in gastric cancer: Significance of positive number. Oncology. 1995; 52 45-50
- 29 de Manzoni G, Verlato G, Guglielmi A, et al. Prognostic significance of lymph node dissection in gastric cancer. Br J Surg. 1996; 83 1604-1607
- 30 Siewert J R, Böttcher K, Stein H, et al. Relevant prognostic factors in Gastric Cancer; ten-year results of the German gastric cancer study. Ann Surg. 1998; 228 449-461
- 31 Siewert J R, Stein H J, Böttcher K. Lymphadenektomie bei Tumoren des oberen Gastrointestinaltrakts. Chirurg. 1996; 67 877-888
- 32 Siewert J R, Kestlmeier R, Busch R, et al. Benefits of D2 lymph node dissection for patients with gastric cancer and pN0 and pN1 lymph node metastases. Br J Surg. 1996; 83 1144-1147
- 33 Hermanek P. Differenziertes chirurgisches Vorgehen bei der kurativen Therapie des Magenkarzinoms. Leber Magen Darm. 1996; 26 64-72
- 34 Isozaki H, Okajima K. How to reduce surgical complications after extended gastric surgery. Dig Surg. 1994; 11 78-85
- 35 Kodera Y, Yamamura Y, Shimizu Y, et al. Lack of benefit of combined pancraticosplenectomy in D2 resection for proximal-third gastric carcinoma. World J Surg. 1997; 21 622-628
- 36 Maruyama K, Sasako M, Kinoshita T, et al. Pancreas-preserving total gastrectomy for proximal gastric cancer. World J Surg. 1995; 19 532-536
- 37 Meyer H J, Jähne J, Weimann A, et al. Chirurgische Therapie des Magenkarzinoms - Indikationen zur Splenektomie bei der Gastrektomie. Chirurg. 1994; 65 437-440
- 38 Kajitani T. The general rules for the gastric cancer study in surgery and pathology. Part I. Clinical classification Jpn J Surg. 1981; 11 127-139
- 39 Kajitani T. The general rules for the gastric cancer study in surgery and pathology. Part II. Histological classification of gastric cancer. Jpn J Surg. 1981; 11 140-145
-
40 Sobin L H, Wittekind C.
UICC-TNM Classification of Malignant Tumors. 5th ed. New York; Wiley & Sons 1997 - 41 Hanazaki K, Sodeyama H, Mochizuki Y, et al. Efficacy of extended lymphadenectomy in the noncurative gastrectomy for advanced gastric cancer. Hepato-Gastroenterol. 1999; 46 2677-2682
- 42 Hüscher C, Chiodini S, Freni V, et al. Adequacy of paracardial dissection in subtotal versus total gastrectomy. Br J Surg. 1992; 79 942-944
- 43 Wagner P K, Ramaswamy A, Rüschoff J, et al. Lymph node counts in the upper abdomen: anatomical basis for lymphadenectomy in gastric cancer. Br J Surg. 1991; 78 825-827
- 44 Dent D M, Madden M V, Price S K. Controlled trials and the R-1/R-2 controversy in the management of gastric carcinoma. Surg Oncol Clinics North Am. 1993; 2 433-441
- 45 Robertson C S, Chung S CS, Woods S DS, et al. A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer. Ann Surg. 1994; 220 176-182
- 46 Bollschweiler E, Boettcher K, Hoelscher A H, et al. Preoperative assessment of lymph node metastases in patients with gastric cancer: evaluation of the Maruyama computer program. Br J Surg. 1992; 79 156-160
- 47 Parikh D, Johnson M, Chagla L, et al. D2 gastrectomy: lessons from a prospective audit of the learning curve. Br J Surg. 1996; 83 1595-1599
- 48 Whiting J L, Fielding J WL. Radical surgery for early gastric cancer. Eur J Surg Oncol. 1998; 24 263-268
- 49 Namieno T, Koito K, Higashi T, et al. Assessing the suitability of gastric carcinoma for limited resection: Endoscopic prediction of lymph node metastases. World J Surg. 1998; 22 859-864
- 50 Miwa K, Miyazaki I, Sahara H, et al. Rationale for extensive lymphadenectomy in early gastric carcinoma. Br J Cancer. 1995; 72 1518
Prof. Dr. med. H.-J. Meyer
Klinik für Allgemein- und Viszeralchirurgie
Städtisches Klinikum Solingen
Gotenstraße 1
42653 Solingen