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Zentralbl Chir 2025; 150(02): 158-162
DOI: 10.1055/a-2537-7546
Übersicht

Erweiterte Lymphadenektomie bei rechtsseitigem Kolonkarzinom – eine Übersichtsarbeit

Extended Complete Mesocolic Excision in right-sided Colon Cancer – An Overview
Sven Flemming 
1   Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland (Ringgold ID: RIN27207)
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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


Publikationsverlauf

Eingereicht: 09. Dezember 2024

Angenommen: 06. Februar 2025

Artikel online veröffentlicht:
08. April 2025

© 2025. Thieme. All rights reserved.

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