Lymphknotendissektion bei Karzinomen des unteren Gastrointestinaltraktes

Hohenberger, Werner; Lux, P.; Merkel, Susanne; Weber, Klaus

doi:10.1007/s00104-011-2117-5

Cited by 8 publications

(1 citation statement)

References 52 publications

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“…From experience with individual cases, we are learning about patterns of lymphogenic spread of metastases [65]. If a patient develops a locoregional recurrence in the lymph nodes left behind after supposed radical lymph node dissection at primary surgery, is reoperated on curatively, and survives for more than 10 years, it is evident that he has been cured by the second operation and the extended lymph node dissection, which should have been indicated at the first intervention.…”

Section: Extent Of Central Lymph Node Dissectionmentioning

confidence: 99%

Extended Lymphadenectomy in Colon Cancer is Crucial

Keßler

Hohenberger

2013

World j. surg.

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No one doubts that lymph node dissection in colon cancer is necessary, it is just the extent of that dissection that is still under debate. As the individual steps of an oncologic operation cannot be separated from each other, analysis of the significance of lymph node dissection alone is difficult. It has been proven that the T category is directly related to the number and central spread of lymph node metastases. Micrometastases and isolated tumor cells may be detected in lymph nodes by using special staining techniques; their presence may worsen prognosis significantly and approximate it to UICC stage III. The numbers of dissected lymph nodes and the ratio of involved versus dissected lymph nodes have been used as markers for quality of surgery and histopathological evaluation. Recent results underscore the importance of technique and extent of dissection. Dissection must be performed along the embryologic planes of the mesocolon and leave them intact. A high vascular tie with preservation of the central hypogastric nerves must be applied in order to achieve the best oncologic results while preserving quality of life. Extended lymphadenectomy is oncologically relevant only when it is combined with removal of the primary tumor with adequate longitudinal clearance, an intact complete mesocolon, and high vascular tie. It is part of a concept in which the tumor-bearing specimen is harvested as an enveloped package to minimize the risk of tumor cell spillage and local recurrence.

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Section: Extent Of Central Lymph Node Dissectionmentioning

confidence: 99%