Aktuelle Fortschritte in der Diagnostik und chirurgischen Therapie der Halslymphknotenmetastasen bei Kopf-Hals-Karzinomen

Zusammenfassung

Der Status der Halslymphknoten ist auch heute noch der wichtigste prognostische Faktor bei Kopf-Hals-Karzinomen. So richtet sich das individuelle Behandlungskonzept der Lymphabflusswege nach der Behandlung des Primärtumors sowie dem Vorliegen oder Fehlen suspekter Lymphknoten in der bildgebenden Diagnostik. Die Neck dissection kann sowohl eine therapeutische als auch eine diagnostische Zielsetzung haben. Die selektive Neck dissection ist zur Zeit das Verfahren der Wahl bei Patienten mit fortgeschrittenen Kopf-Hals-Karzinomen und einem klinischen N0-Hals. Dieses Verfahren ist aus onkologischen Gründen bei akzeptalen funktionellen und ästhetischen Ergebnissen grundsätzlich zu empfehlen, vor allem unter dem Gesichtspunkt des vorerwähnten Staging-Verfahrens. In diesem Übersichtsartikel werden aktuelle Aspekte zum prä- und posttherapeutischen Staging der Halslymphknoten dargestellt und die Indikation und notwendige Ausdehnung der Neck dissection bei Kopf-Hals-Karzinomen diskutiert. Zusätzlich wird die kritische Frage behandelt, ob die Lymphknotenmetastase ein intrinsisches Risiko zur metastatischen Ausbreitung hat und damit deren Entfernung im frühesten Stadium von besonderer Bedeutung ist.

Abstract

Current Advances in Diagnosis and Surgical Treatment of Lymph Node Metastasis in Head and Neck Cancer

Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role.

Schlüsselwörter

Kopf-Hals-Karzinome - lymphogene Metastasierung - Lymphknotenmetastasen - Neck dissection

Key words

head and neck cancer - lymphogenic metastasis - lymph node metastasis - neck dissection

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