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Lymphknotenmanagement beim cN0-Peniskarzinom

Lymph node management of cN0 penile cancer

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Zusammenfassung

Beim klinisch lokalisierten Peniskarzinom stellt der Lymphknotenstatus den wichtigsten Prognosefaktor für das Überleben des Patienten dar. Die frühzeitige Resektion klinisch okkulter Metastasen kann das Überleben im Vergleich zur zeitlich verzögerten Resektion von klinisch auffälligen Makrometastasen verbessern. Mittels Bildgebung können Mikrometastasen nicht ausreichend sicher detektiert und Nomogramme das individuelle Risiko für einen Lymphknotenbefall, basierend auf klinischen und histopathologischen Tumorcharakteristika, nur sehr eingeschränkt vorhersagen. Aus diesem Grund wird die operative Exploration des klinisch unauffälligen Lymphknotenstatus (cN0) beim Peniskarzinom ab einem Tumorstadium pT1, G2 empfohlen. Die radikale inguinale Lymphadenektomie ist wegen ihrer Invasivität und hohen Komplikationsrate nicht mehr zu empfehlen. Sowohl die sog. modifizierte Lymphadenektomie mit Einschränkung des Lymphdissektionsgebiets als auch die dynamische Sentinel-Lymphknotenchirurgie ermöglichen mit ausreichender Sicherheit die Identifikation lymphknotenpositiver Patienten. Dabei ist die Sentinel-Lymphknotendetektion sicherlich zurzeit das Verfahren mit der geringsten Invasivität bei zugleich hoher Sensitivität. Eine extendierte inguinale Lymphadenektomie wird bei einem hieraus resultierenden positiven Lymphknotenstatus zurzeit noch ergänzend empfohlen.

Abstract

In penile cancer, lymph node metastasis is the main known prognostic factor affecting patients’ survival. Early inguinal lymph node dissection or the resection of clinically occult lymph node metastases improves survival compared with removal when the metastases become clinically apparent. Micrometastatic lymph node involvement is undetectable by current imaging modalities. Nomograms based on clinical and histopathological tumor characteristics are unreliable in predicting lymph node involvement. Consequently, in penile cancer patients with clinically normal inguinal lymph nodes (cN0) and a tumor stage ≥pT1, G2 surgical lymph node exploration is recommended. Radical inguinal lymphadenectomy is no longer recommended because of its invasiveness and high complication rate. Modified lymphadenectomy and dynamic sentinel lymph node surgery allow the detection of lymph node-positive patients with sufficient certainty. Thereby, the sentinel lymph node approach offers the least invasiveness and high sensitivity. Extended inguinal lymphadenectomy is still recommended in the case of positive nodes.

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Authors and Affiliations

  1. Universitätsklinik für Urologie, Klinikum Oldenburg, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland

    F. Wawroschek &  A. Winter

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Correspondence to F. Wawroschek.

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F. Wawroschek und A. Winter geben an, dass kein Interessenkonflikt besteht.

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

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Wawroschek, F., Winter, A. Lymphknotenmanagement beim cN0-Peniskarzinom. Urologe 57, 435–439 (2018). https://doi.org/10.1007/s00120-018-0598-2

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