Metastasierungsweg und Lymphknotenausräumung beim Unterlippenkarzinom

Leitthema
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Zusammenfassung

Bei den meisten bösartigen Neubildungen der Unterlippe handelt es sich um Plattenepithelkarzinome. Mit einer lymphogenen Metastasierungshäufigkeit von ca. 8 % lassen sie sich in ihrem Metastasierungsverhalten zwischen den Plattenepithelkarzinomen der Haut (4–5 %) und dem Mundhöhlenkarzinom (20–40 %) einordnen. Vorwiegend betroffen sind die submentalen und submandibulären Lymphknotenstationen (Level I a und I b), in absteigender Häufigkeit dann die Lymphknoten entlang der Hals-Gefäß-Nerven-Scheide (Level II, III und IV). Das Risiko von Lymphknotenmetastasen steigt mit zunehmender Tumordicke und höherem Entdifferenzierungsgrad (histologisches Grading). Aus der Kombination dieser Faktoren können Patienten mit erhöhtem Metastasierungsrisiko identifiziert werden. Weitere Risikofaktoren sind Tumorgröße, Immunsuppression, perineurales Wachstum, Lymphgefäßinvasion und häufige Rezidive. Bei Patienten mit erhöhtem Risiko für nodale Metastasen sollte auch bei im Staging unauffälligem Lymphknotenstatus (cN0) eine elektive Lymphknotenchirurgie in Erwägung gezogen werden. In der Regel ist dabei eine selektive funktionelle suprahyoidale (Level I und II) oder supraomohyoidale (Level I–III) Ausräumung ausreichend. Eine Erweiterung um weitere Level oder zum modifizierten radikalen Vorgehen ist nur bei Vorliegen von Metastasen notwendig. Alternativ kann auch eine Wächterlymphknotenbiopsie erfolgen, wobei hierzu umfangreiche evidenzsichernde Daten noch fehlen. Die Lymphknotenchirurgie kann sowohl zusammen mit der Primärtumorresektion und meist sofortigen Unterlippenrekonstruktion (einzeitiges Vorgehen) als auch später sekundär (zweizeitiges Vorgehen) erfolgen.

Schlüsselwörter

Plattenepithelkarzinom Lymphknotenmetastase Wächterlymphknoten Risikofaktoren Prognose 

Metastatic pathways and lymph node dissection in lower lip cancer

Abstract

The most common histologic entity among lower lip neoplasms is squamous cell carcinoma (SCC). Nodal metastasis is found in approximately 8% of patients, a figure which lies between the dissemination prevalence rates of cutaneous (4–5%) and oral SCC (20–40%). The submental and submandibular lymph nodes (level I a and I b) are most often involved, and nodal metastases are found with decreasing frequency in the cervical nodes of levels II, III and IV along the jugular and carotid sheath. The risk for nodal dissemination rises with increasing tumor depth and dedifferentiation (histologic grading), factors which can be combined to identify patients with a higher risk for nodal metastases. Further risk factors are tumor size, immunosuppression, perineural spread, lymph vessel invasion, and frequent tumor recurrence. In patients with a higher risk for nodal metastases elective lymph node surgery/dissection (ELND) should be considered, even if staging shows no evidence for dissemination (cN0). Selective lymph node dissection (SLND) of level I and II (suprahyoidal SLND) or level I–III (supraomohyoidal SLND) are adequate in cN0 cases. Extension to further levels or modified radical neck dissection is only necessary when metastases are present. Alternatively, sentinel lymph node biopsy (SLNB) can be performed, although adequate evidence-based data on SLNB are currently unavailable. Lymph node surgery in lip cancer can be performed together with resection of the primary tumor and lip reconstruction, or later in a secondary procedure.

Keywords

Squamous cell carcinoma Lymphatic metastasis Sentinel lymph node Risk factors Prognosis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K. Wermker gibt 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 Mund-Kiefer-Gesichtschirurgie, plastische und ästhetische Operationen, Zentrum für dentale ImplantologieKlinikum OsnabrückOsnabrückDeutschland

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