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HNO

, Volume 67, Issue 1, pp 61–76 | Cite as

Neck-Dissection – Die operative Behandlung der zervikalen Lymphabflusswege

  • J. M. VahlEmail author
  • T. K. Hoffmann
CME
  • 101 Downloads

Zusammenfassung

Die Neck-Dissection (ND) ist fester Bestandteil der Therapie von Kopf-Hals-Tumoren. Insbesondere bei Plattenepithelkarzinomen (PEK) richtet sich das Ausmaß der ND nach Primärlokalisation, T‑ und N‑Stadium. Sowohl bei einem cN+-Hals als auch bei einem cN0-Hals und Primärtumor mit erhöhtem Risiko für okkulte Metastasen zeigten Studien ein durch die ND verbessertes Überleben. Dieses wird zudem durch eine hohe Sorgfalt bei der Operation (Lymphknotenmenge bzw. deren Ratio) begünstigt. Im prognostischen Modell der TNM-Klassifikation umfasst „N“ nicht nur die Anzahl betroffener Lymphknoten, sondern auch deren Größe und extrakapsuläre Tumorextension. Ebenfalls berücksichtigt wurde aufgrund einer günstigeren Prognose das Vorhandensein des humanen Papillomvirus (HPV). Zur Reduktion der Morbidität einer ND wird versucht, deren Ausmaß einzuschränken, ohne die Überlebenszeit zu verringern. Dahingehend werden Ansätze wie die Wächterlymphknotenbiopsie sowie Überwachung mittels PET-CT (Positronenemissionstomographie-Computertomographie) bei cN0-Halsstatus oder nach primärer Radio(chemo)therapie geprüft.

Schlüsselwörter

Kopf-Hals-Tumor Plattenepithelkarzinom Metastase Wächterlymphknoten PET-CT 

Neck dissection—Surgical treatment of cervical lymphatic drainage pathways

Abstract

Neck dissection (ND) is an essential component of treatment in head and neck squamous cell carcinoma (HNSCC). The extent of ND depends on primary tumor location and T and N stage. Trials have demonstrated improved survival for cN+ status with therapeutic ND as well as for cN0 status with selective ND if the primary has a high incidence of occult metastasis. The accuracy of the procedure is of prognostic relevance. In the prognostic model of the TNM classification, the parameter “N” does not only reflect the number of affected lymph nodes, but also their size and extranodal tumor extension. Due to its better prognosis, a positive human papillomavirus (HPV) status is also incorporated in the present TNM classification. In order to minimize morbidity after ND, one seeks to limit its extent without reducing survival time. To this aim, sentinel node biopsy or surveillance with positron-emission computed tomography (PET-CT) in cN0 necks or after primary radio(chemo)therapy are being investigated.

Keywords

Head and neck cancer Squamous cell carcinoma Metastasis Sentinel lymph node PET-CT 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J.M. Vahl und T.K. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Hals‑, Nasen‑, Ohrenheilkunde und Kopf-Hals-ChirurgieUniversitätsklinikum UlmUlmDeutschland

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