Lymphadenectomy

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Schematic structure of a lymph node
Lymphadenectomy of a lymph node in the neck.
In this case, the affected lymph node was identified and localized using positron emission tomography and the radiopharmaceutical 18 F- fluorodeoxyglucose (FDG). On the right in the picture the γ-ray detector wrapped in foil
Blue-colored lymph node in the armpit

Under a lymphadenectomy , also lymphadenectomy , lymph node resections , lymph node dissection or lymph node named one understands the operative removal of lymph nodes .

application

Removal of lymph nodes can be done for both diagnostic and therapeutic purposes. Tumor cells can spread ( metastasize ) along the lymphatic system . Lymphadenectomy is therefore usually carried out as part of cancer therapy to remove actual or possible metastases ( oncological resection ) or as a diagnostic lymphadenectomy to obtain tissue samples. These biopsies are then examined in the tissue for pathological changes. In the case of many tumor diseases, the findings of the removed lymph nodes are used to plan the further treatment of the patient. In prostate cancer, for example, lymphadenectomy provides important information about the tumor stage and prognosis .

In retroperitoneal lymphadenectomy (RLA), the lymph nodes in the abdomen are partially or completely removed. If possible, this is done laparoscopically through an incision in the abdominal wall . This procedure is often necessary, for example, when metastasis is caused by a testicular tumor. In extreme cases, the cut can lead from the lower edge of the breastbone over the navel to the penis , with the risk of damaging nerve tracts, which can impair the ability to ejaculate ( retrograde ejaculation ).

Therapeutic benefit

Lymphadenectomy has been a standard procedure in cancer surgery since the beginning of the 20th century. In the meantime, a number of studies and epidemiological data from cancer registries show that lymph nodes of solid primary tumors affected by tumor cells are apparently unable to initiate metastases. According to these data, routine and systematic lymphadenectomy has no effect on patient survival, regardless of whether the lymph nodes are metastatic or not. The data, as well as the conclusions drawn from it, are controversially discussed in specialist circles.

Elective lymph node dissection

In elective lymph node dissection (elective = 'selected'), entire groups of lymph nodes are prophylactically removed without evidence of tumor cell involvement. This procedure is not a useful supplement to therapy, especially for breast cancer and malignant melanoma . For example, elective lymph node dissection did not improve the prognosis for malignant melanoma, which is why this procedure is no longer the standard therapy for these types of cancer.

Sentinel lymphadenectomy

The concept of removing the sentinel lymph node ( sentinel lymphadenectomy ) is completely different . It is based on the fact that a metastatic tumor drains its lymph to the first lymph node, the sentinel lymph node . The sentinel lymph node serves as an indicator for the surrounding lymph nodes: if the sentinel lymph node is not infected, the lymph nodes in the vicinity are probably also tumor-free. The procedure was developed in order not to have to remove unnecessarily many unaffected lymph nodes. With each additional lymph node removed, the risk of developing lymphedema increases. However, if the sentinel lymph node is affected, the entire affected lymphatic tissue is usually removed, depending on the extent of the spread of the cancer cells. In these cases one speaks of a systematic lymphadenectomy .

With the help of lymph scintigraphy , the position of the sentinel lymph node can be pinpointed before it is removed. Another possibility for marking is the injection of a dye solution of patent blue . This food coloring accumulates in the sentinel lymph node.

execution

The lymph nodes are removed in separate surgical procedures. Depending on the location of the affected lymph node, the procedure can also be minimally invasive , for example laparoscopic .

Possible consequences of a lymphadenectomy

One of the most common complications of lymphadenectomy is the development of lymphedema. This is the accumulation of fluid in the intercellular space , which is caused by insufficient removal of the lymph via the lymphatic vessels. As the number of removed lymph nodes increases, the likelihood of developing lymphedema increases.

In pelvic lymphadenectomy (removal of the lymph nodes in the pelvic cavity), lymphoceles occur in around 10% of patients , thrombosis in around 6%, and embolism or lymphedema in around 1% each as complications. The values ​​are heavily dependent on the respective surgeon. With extensive lymphadenectomy, the rate is for a re-intervention at over 50%.

further reading

Individual evidence

  1. ↑ Fiona C. Burkhard and Urs E. Studer: Significance of lymphadenectomy in prostate cancer. (PDF; 70 kB) In: Deutsches Ärzteblatt 101, 2004, pp. A2182 – A2185.
  2. ↑ F. Wawroschek et al.: Sentinel lymphadenectomy in prostate cancer. In: Der Urologe B pp. 409-410. doi : 10.1007 / s00131-002-0241-8
  3. ↑ V. Zylka-Menhorn: Carcinoma surgery: Is the lymphadenectomy no longer appropriate ? In: Dtsch Arztebl 106, 2009, pp. A-1353 / B-1151 / C-1123
  4. ↑ C. Gebhardt and H. Näher: Standards and trends in the treatment of malignant melanoma. In: Onkopipeline 2, 2009, pp. 101-113. doi : 10.1007 / s15035-009-0161-0
  5. ↑ T. Rath et al.: Malignant melanoma of the skin. ( Memento of January 12, 2008 in the Internet Archive ) Austrian Society for Surgical Oncology, accessed on January 28, 2010
  6. ↑ P. Heidenreich et al.: The concept of the sentinel lymph node: status and clinical significance. In: Deutsches Ärzteblatt 98, 2001, pp. A-534 / B-434 / C-408
  7. ↑ D. Bachter et al.: Sentinel lymphadenectomy in malignant melanoma. In: Der Nuklearmediziner 4, 1999, pp. 245-252.
  8. ↑ a b c Cervical cancer: What surgical procedures are there? - Lymph node removal for diagnosis and therapy. , Cancer Information Service of the German Cancer Research Center (DKFZ), Heidelberg. June 16, 2006. Retrieved September 4, 2014.
  9. ↑ K. Lehzen: Sentinel lymph node dissection in malignant melanoma. (PDF; 854 kB) Dissertation, University of Münster, 2007
  10. ↑ W. Loidl, D. Weckermann: Sentinel lymph node removal in prostate cancer - a logical concept? (PDF; 546 kB) In: J Uro Urogynäkol 16, 2009, pp. 4–6.

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