CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(12): 1221-1228
DOI: 10.1055/a-1120-0138
GebFra Science
Review/Übersicht

Pelvine Lymphonodektomie beim Vulvakarzinom – Wohl oder Übel?

Artikel in mehreren Sprachen: English | deutsch
Linn Woelber
1   Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Mareike Bommert
2   Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
,
Katharina Prieske
1   Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
28   Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Inger Fischer
1   Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Christine zu Eulenburg
3   Department of Epidemiology, UMCG, Universität Groningen, Groningen, Netherlands
,
Eik Vettorazzi
4   Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Philipp Harter
2   Department of Gynecology and Gynecologic Oncology Kliniken Essen-Mitte, Essen, Germany
,
Julia Jueckstock
5   Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
,
Felix Hilpert
6   Oncologic Medical Center at the Jerusalem Hospital Hamburg, Hamburg, Germany
,
Niko de Gregorio
7   Department of Obstetrics and Gynecology, University of Ulm Medical Center, Ulm, Germany
,
Severine Iborra
8   Gynecology and Gynecologic Oncology, Uniklinik RWTH Aachen, Aachen, Germany
,
Jalid Sehouli
9   Department of Gynecology, Charité University Medicine Berlin, Campus Virchow, Berlin, Germany
,
Atanas Ignatov
10   Department of Obstetrics and Gynecology, University Hospital Magdeburg, Magdeburg, Germany
,
Peter Hillemanns
11   Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
,
Sophie Fuerst
5   Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
,
Hans-Georg Strauss
12   Department of Gynecology, University Hospital Halle, Halle, Germany
,
Klaus Baumann
13   Department of Gynecology, Medical Center Ludwigshafen, Ludwigshafen, Germany
,
Matthias Beckmann
14   Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Alexander Mustea
15   Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, Bonn, Germany
,
Werner Meier
16   Department of Obstetrics and Gynecology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
,
Pauline Wimberger
17   Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
,
Lars Hanker
18   Department of Gynecology and Gynecologic Oncology, University Medical Center Lübeck, Lübeck, Germany
,
Ulrich Canzler
17   Department of Gynecology and Obstetrics, University Hospital Dresden, TU Dresden, Dresden, Germany
,
Tanja Fehm
19   Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
,
Alexander Luyten
20   Department of Gynecology and Obstetrics, Medical Center Wolfsburg, Wolfsburg, Germany
,
Martin Hellriegel
21   Department of Gynecology and Gynecologic Oncology, University Medical Center Göttingen, Göttingen, Germany
,
Jens Kosse
22   Department of Gynecology and Obstetrics, Sana Klinikum Offenbach, Offenbach, Germany
,
Christoph Heiss
23   Department of Gynecology, Medical Center am Eichert, Alb Fils Clinic, Klinik am Eichert, Göppingen, Germany
,
Peer Hantschmann
24   Department of Gynecology and Obstetrics, Medical Center Altötting, Altötting, Germany
,
Peter Mallmann
25   Department of Gynecology and Gynecologic Oncology, University Medical Center Köln, Köln, Germany
,
Berno Tanner
26   Department of Gynecology and Obstetrics, Medical Center Oranienburg, Oranienburg, Germany
,
Jacobus Pfisterer
27   Gynecologic Oncology Center Kiel, Kiel, Germany
,
Sven Mahner
5   Department of Gynecology and Obstetrics, University Hospital, LMU-University of Munich, Munich, Germany
,
Barbara Schmalfeldt
1   Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Anna Jaeger
1   Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Institutsangaben

Zusammenfassung

Seit der Veröffentlichung der aktualisierten deutschen Leitlinie 2015 hat sich die Empfehlung zur pelvinen Lymphonodektomie (LNE) bei Patientinnen mit Vulvakarzinom (VSCC) grundlegend verändert – die Durchführung eines operativen Lymphknoten-Stagings wird darin bei allen Patientinnen mit erhöhtem Risiko für eine pelvine Lymphknotenbeteiligung empfohlen. Allerdings ist die Risikopopulation anhand der aktuellen Datenlage unscharf definiert und daher die Indikation zum Eingriff in der Praxis weiterhin unklar. Um sowohl den prognostischen Einfluss einer histologisch gesicherten pelvinen Lymphknotenmetastasierung als auch den Zusammenhang zwischen inguinaler und pelviner Lymphknotenbeteiligung zu beleuchten, stehen aktuell 2 deutsche Kollektive von Patientinnen mit pelviner LNE zur Verfügung: in der multizentrischen AGO-CaRE-1-Studie wurden insgesamt 1618 Patientinnen mit primärem VSCC FIGO-Stadium ≥ IB (1998 – 2008) dokumentiert, davon erhielten 70 eine pelvine LNE; im Zuge einer retrospektiven monozentrischen Auswertung am UKE wurden von 1996 – 2018 insgesamt 514 Patientinnen mit primärem VSCC ausgewertet, hiervon 21 mit pelviner LNE. In beiden Kollektiven waren ca. 80% der Patientinnen mit durchgeführter pelviner LNE inguinal nodal positiv mit einer medianen Anzahl von 3 betroffenen Leistenlymphknoten. Pelvine Lymphknotenmetastasen ohne inguinale Lymphknotenmetastasen wurde in beiden Kollektiven nicht beobachtet. Zwischen 33 – 35% der inguinal nodal positiven Patientinnen waren pelvin ebenfalls nodal positiv, bei diesen war die mediane Anzahl betroffener Leistenlymphknoten hoch mit > 4 und einem medianen Maximaldurchmesser der größten inguinalen Metastase von > 40 mm in beiden Kohorten. Für die Mehrheit nodal positiver Patientinnen mit VSCC ist damit vermutlich weder ein pelvines Lymphknoten-Staging noch eine pelvine Radiotherapie notwendig, da ein relevantes Risiko für eine pelvine Lymphknotenbeteiligung vor allem in hochgradig nodal positiven Fällen besteht. Für eine valide Vorhersage des Zusammenhangs zwischen inguinaler und pelviner Lymphknotenbeteiligung bedarf es weiterführender prospektiver Datenerhebungen.



Publikationsverlauf

Eingereicht: 09. Juli 2020

Angenommen nach Revision: 12. Oktober 2020

Artikel online veröffentlicht:
03. Dezember 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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