Sentinel Lymphonodektomie, komplette regionale Lymphadenektomie oder keine Lymphknotenchirurgie?

Zusammenfassung

Das Multicenter Selective Lymphadenectomy Trial 1, in welchem eine frühzeitige Exzision von Lymphknotenmetastasen maligner Melanome nach Sentinel-Lymphonodektomie (SLNE) mit Beobachtung verglichen wird, hat ein widersprüchliches Ergebnis erbracht. Die Gesamtpopulation der Patienten mit primären Melanomen (Breslow-Index 1,2 – 3,5 mm) konnte hinsichtlich des Overall-Survivals nicht vom Sentinel-Verfahren profitieren. Dagegen fand sich ein signifikanter Vorteil für Patienten mit Frühexzision von Lymphknotenmetastasen durch SLNE und komplette regionale Lymphadenektomie, verglichen mit Patienten, bei denen im weiteren Verlauf der Erkrankung eine Lymphadenektomie klinisch vergrößerter Lymphknotenmetastasen durchgeführt wurde. Die vorliegende Arbeit versucht, die Ergebnisse zu interpretieren und Schlussfolgerungen für den klinischen Alltag zu finden.

Abstract

The Multicenter Selective Lymphadenectomy Trial 1, comparing the sentinel procedure with observation, was recently published. Unfortunately, there was no OS benefit in the whole population of patients with intermediate thick primary melanomas (Breslow-Index 1.2 – 3.5 mm). However, lymph node positive patients seemed to benefit from early performed lymph node excision. The survival rate was significantly improved for the subgroup with positive SNB and subsequent immediate CLND, when compared with observation and delayed CLND for clinical nodal recurrence only. In the present paper, we try to interpret these conflicting results.

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