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DOI: 10.1055/s-2000-6911
© Georg Thieme Verlag Stuttgart · New York
Stellenwert der Lymphadenektomie bei der operativen Therapie des Nierenzellkarzinoms
Publication History
Publication Date:
31 December 2000 (online)
Zusammenfassung.
Die Standardtherapie des nicht metastasierten Nierenzellkarzinoms ist die operative Entfernung des Primärtumors. Dagegen wird in der Literatur der Stellenwert der zusätzlichen ausgedehnten, retroperitonealen Lymphadenektomie für Staging und Prognose des Nierenzellkarzinoms kontrovers diskutiert. Bisher konnte ein positiver Einfluss der ausgedehnten Lymphadenektornie auf die Prognose der Patienten lediglich in retrospektiven Arbeiten gezeigt werden, die einzig prospektiv randomisierte Untersuchung zu dieser Fragestellung ist derzeit noch nicht endgültig ausgewertet. Übereinstimmung besteht lediglich in dem Zugewinn an diagnostischer Sicherheit durch die Lymphadenektomie. Auf dem Hintergrund der lokalen Tumorkontrolle und der Möglichkeit adjuvanter Therapiemaßnahmen empfehlen wir jedoch weiterhin die Lymphadenektomie im Rahmen der operativen Therapie des Nierenzellkarzinoms, zumindest bis weitere Daten zur Klärung dieser Fragestellung vorliegen.
The significance of lymph node dissection in the surgical treatment of renal cell carcinoma.
The management of organ-confined renal cell carcinoma is primarily surgical. The value of an additional systematic lymphadenectomy for staging and its effect on prognosis remain controversial. A therapeutic benefit of an extensive lymphadenectomy has been demonstrated only in retrospectively designed studies. The only prospective randomized study on the subject has yet to be evaluated. However, there is a consensus that the additional lymph node dissection improves the accuracy of pathologic staging. Based on the principle of local tumor control and based on achieving optimal prerequisites for postoperative immunochemotherapy, we continue to recommend the lymphadenectomy for patients with renal cell carcinoma until prospectively designed studies have provided definitive guidelines.
Schlüsselwörter:
Nierenzellkarzinom - Lymphadenektomie - Prognose - pathologisches Staging - Übersicht
Key words:
renal cell carcinoma - lymph node dissection - prognosis - staging - review
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