Zusammenfassung
Die Indikation zur retroperitonealen Lymphadenektomie (RLA) beim Hodentumor ist abhängig vom Stadium und der erfolgten Primärtherapie. Beim Nichtseminom im klinischen Stadium I stellt sie eine adjuvante Option dar; sie erfolgt in diagnostischer Absicht zur Sicherung des Stadiums bei in bis zu 30% falsch-negativer Bildgebung. Gleichzeitig ist sie bei Vorliegen eines höheren Stadiums eine therapeutische Option; allerdings ist ihr Stellenwert als adjuvante Maßnahme gegenüber der Surveillance und der Chemotherapie gesunken, da anhand von Risikofaktoren Patienten mit niedrigem Rezidivrisiko für die Surveillance und solche mit hohem Rezidivrisiko für die adjuvante Chemotherapie selektioniert werden können.
Bei der RLA nach Chemotherapie und Vorliegen von Restbefunden steht der therapeutische Aspekt im Vordergrund. Die histologische Beurteilung des Resektats hat prognostische und therapiesteuernde Bedeutung. Die Resektion von Metastasen bei chemotherapierefraktären Befunden ist für etwa 25% der Patienten eine kurative Option.
Abstract
The rationale to perform retroperitoneal lymph node dissection (RPLND) in testicular cancer depends on the clinical stage and previous therapy. Thus, it can be performed either with diagnostic, prognostic, or therapeutic intention. In verified clinical stage I nonseminoma, RPLND provides one of three adjuvant options. To verify the clinical stage pathologically, surgery is done for diagnostic reasons, since CT scanning provides a false-negative staging in up to 30%. In higher stage lesions RPLND is a therapeutic procedure. The importance, however, of RPLND in clinical stage I nonseminoma is decreasing, since prognostic factors are available to stratify patients with either low or high risk for recurrence. Thus, these patients are selected for surveillance (low risk) or adjuvant chemotherapy (high risk).
RPLND after chemotherapy is done for resection of residual tumor with a therapeutic intention. The histology of the residual mass is of prognostic importance and may help define further therapy. Resection of retroperitoneal metastases in patients with chemorefractory tumors is curative in about 25%.
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Krege, S., Rübben, H. Lymphadenektomie beim Hodentumor. Urologe [A] 44, 652–656 (2005). https://doi.org/10.1007/s00120-005-0824-6
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DOI: https://doi.org/10.1007/s00120-005-0824-6