Skip to main content
SpringerLink
Log in

Lymphknotenstaging bei Genitalkarzinomen – wohin geht die Reise?

Lymph node staging in genital carcinomas—Where does the journey lead to?

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die lymphogene Metastasierung ist bei genitalen Karzinomen ein wichtiger diagnostischer und prognostischer Parameter. Zunehmend wird aber die therapeutische Bedeutung der operativen Resektion von Lymphknoten diskutiert. Systematische Lymphonodektomien bergen darüber hinaus ein erhebliches Morbiditätsrisiko, weshalb die Indikation jeweils kritisch geprüft werden muss. Zunehmende Bedeutung gewinnt die Sentinel-Node-Biopsie (SNB), die ein Lymphknotenstaging bei geringem Komplikationsrisiko ermöglichen kann. Bei fortgeschrittenen Ovarialkarzinomen und beim Endometriumkarzinom zeigt sich nach aktuellem Kenntnisstand kein Überlebensvorteil nach systematischer Lymphonodektomie und auch die pelvine Lymphonodektomie beim Vulvakarzinom wird kontrovers diskutiert. Die SNB beim Vulva- und Endometriumkarzinom wurde in einer größeren Anzahl von Studien evaluiert und sollte bei entsprechender Indikation in der Klinik eingesetzt werden. Die SNB kann u. U. zudem bei frühen Zervixkarzinomen eingesetzt werden. Beim frühen Ovarialkarzinom werden in den nächsten Jahren Daten zur SNB aus der SELLY-Studie erwartet. Die diagnostische Bedeutung der systematischen Lymphonodektomie beim Zervixkarzinom bleibt derzeit hoch. So erfolgt bei pelvinen Lymphknotenmetastasen anstelle einer radikalen Hysterektomie in der Regel eine primäre Radiochemotherapie. Im folgenden Artikel werden aktuelle Erkenntnisse in Bezug auf Lymphonodektomien bei genitalen Karzinomen dargestellt.

Abstract

Lymphogenic metastasis is an important diagnostic and prognostic parameter of genital carcinomas; however, the therapeutic value of surgical lymph node resection is increasingly being discussed. In addition, systematic lymph node resection has a significant risk of morbidity, which is why the indications should be carefully verified. The importance of sentinel lymph node biopsies (SNB) has been increasing for years as it often enables adequate lymph node staging with a low risk of complications. According to the state of the art, systematic lymph node resection does not improve the survival rates in advanced ovarian cancer and endometrial carcinomas. Systematic pelvic lymph node resection in advanced vulvar neoplasms is also controversially discussed. The SNB in endometrial and vulvar cancers was extensively investigated and should be clinically applied with appropriate indications. In early cervical cancer SNB can also be an adequate treatment option. Within the next years the results of the SELLY study concerning SNB in early ovarian cancers are expected. The diagnostic relevance of systematic lymph node resection in cervical carcinomas currently remains high. In the case of pelvic lymph node metastases, chemoradiotherapy is usually applied instead of radical hysterectomy. This article presents the current state of knowledge concerning lymph node resection in genital carcinomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Gaß P (2015) AWMF-Leitlinie Diagnostik, Therapie und Nachsorge des Vulvakarzinoms und seiner Vorstufen. S2k-Leitlinie, S 181

  2. Klapdor R, Wölber L, Hanker L et al (2019) Predictive factors for lymph node metastases in vulvar cancer. An analysis of the AGO-CaRE‑1 multicenter study. Gynecol Oncol 154:565–570

    Article  Google Scholar 

  3. Dall P, Hildebrandt T, du Bois A et al (2020) Feasibility of internal inguinoperitoneal drainage after inguinofemoral lymphadenectomy in vulvar cancer. Arch Gynecol Obstet 301:1513–1519

    Article  Google Scholar 

  4. van der Velden J (2000) Surgical interventions for early squamous cell carcinoma of the vulva. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002036

    Article  PubMed  PubMed Central  Google Scholar 

  5. Woelber L, Bommert M, Prieske K et al (2020) Pelvic lymphadenectomy in vulvar cancer—does it make sense? Geburtshilfe Frauenheilkd 80:1221–1228

    Article  Google Scholar 

  6. Gaarenstroom KN, Kenter GG, Trimbos JB et al (2003) Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions. Int J Gynecol Cancer 13:522–527

    Article  CAS  Google Scholar 

  7. Dardarian TS, Gray HJ, Morgan MA et al (2006) Saphenous vein sparing during inguinal lymphadenectomy to reduce morbidity in patients with vulvar carcinoma. Gynecol Oncol 101:140–142

    Article  Google Scholar 

  8. Van der Zee AGJ, Oonk MH, De Hullu JA et al (2008) Sentinel node dissection is safe in the treatment of early-stage vulvar cancer. J Clin Oncol 26:884–889

    Article  Google Scholar 

  9. Oonk MHM, Slomovitz B, Baldwin PJW et al (2021) Radiotherapy versus Inguinofemoral lymphadenectomy as treatment for vulvar cancer patients with micrometastases in the sentinel node: results of GROINSS‑V II. J Clin Oncol. https://doi.org/10.1200/JCO.21.00006

    Article  Google Scholar 

  10. Woelber L, Eulenburg C, Kosse J et al (2019) Predicting the course of disease in recurrent vulvar cancer—A subset analysis of the AGO-CaRE-1 study. Gynecol Oncol 154:571–576

    Article  Google Scholar 

  11. Gaß P (2018) Diagnostik. AWMF S2k-Leitlinie Therapie und Nachsorge des Vaginalkarzinoms und seiner Vorstufen, S 207

  12. Skanjeti A, Dhomps A, Paschetta C et al (2019) Sentinel node mapping in gynecologic cancers: a comprehensive review. Semin Nucl Med 49:521–533

    Article  Google Scholar 

  13. Hertel H, Soergel P, Muecke J et al (2013) Is there a place for sentinel technique in treatment of vaginal cancer?: feasibility, clinical experience, and results. Int J Gynecol Cancer 23:1692–1698

    Article  Google Scholar 

  14. Lee IO, Lee J‑Y, Kim S et al (2017) Sentinel lymph node mapping with indocyanine green in vaginal cancer. J Gynecol Oncol 28:e29

    Article  Google Scholar 

  15. Harter P, Gnauert K, Hils R et al (2007) Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer 17:1238–1244

    Article  CAS  Google Scholar 

  16. Harter P, Heitz F, Ataseven B et al (2019) How to manage lymph nodes in ovarian cancer. Cancer 125:4573–4577

    Article  Google Scholar 

  17. Heitz F, Harter P, Ataseven B et al (2018) Stage- and histologic subtype-dependent frequency of lymph node metastases in patients with epithelial ovarian cancer undergoing systematic pelvic and Paraaortic Lymphadenectomy. Ann Surg Oncol 25:2053–2059

    Article  Google Scholar 

  18. Scambia G, Nero C, Uccella S et al (2019) Sentinel-node biopsy in early stage ovarian cancer: a prospective multicentre study (SELLY). Int J Gynecol Cancer 29:1437–1439

    Article  Google Scholar 

  19. Harter P, Sehouli J, Lorusso D et al (2019) A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med 380:822–832

    Article  Google Scholar 

  20. Lopes A, Genta MLND, Costa Miranda V et al (2021) Role of systematic pelvic and PARA-AORTIC lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy cycles for high-grade serous ovarian carcinoma. J Obstet Gynaecol Res. https://doi.org/10.1111/jog.14838

    Article  Google Scholar 

  21. Wagner U, Reuß A. S3-Leitlinie „Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren“: Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF: Langversion 3.0, 2019, AWMF-Registernummer: 032/035OL. Forum 2021; 34: 413–415

  22. Concin N, Matias-Guiu X, Vergote I et al (2021) ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 31:12–39

    Article  Google Scholar 

  23. Candido EC, Rangel Neto OF, Toledo MCS, Torres JCC, Cairo AAA, Braganca JF, Teixeira JC (2019) Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome. Eur J Obstet Gynecol Reprod Biol. https://doi.org/10.1016/j.eurox.2019.100020

    Article  Google Scholar 

  24. Volpi L, Sozzi G, Capozzi VA, Ricco M, Merisio C, Di Serio M, Chiantera V, Berretta R (2019) Long term complications following pelvic and para-aortic lymphadenectomy for endometrial cancer, incidence and potential risk factors: a single institution experience. Int J Gynecol Cancer 29:312–319

    Article  Google Scholar 

  25. Rossi EC, Kowalski DL, Scalici J, Cantrell L, Schuler K, Hanna RK, Method M, Ade M, Ivanova A, Boggess J (2017) A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. Lancet Oncol 18:384–392

    Article  Google Scholar 

  26. Persson J, Salehi S, Bollino M et al (2019) Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)—the final step towards a paradigm shift in surgical staging. Eur J Cancer 116:77–85

    Article  Google Scholar 

  27. Daraï E, Dubernard G, Bats A‑S et al (2015) Sentinel node biopsy for the management of early stage endometrial cancer: Long-term results of the SENTI-ENDO study. Gynecol Oncol 136:54–59

    Article  Google Scholar 

  28. Walker JL, Piedmonte MR, Spirtos NM et al (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27:5331–5336

    Article  Google Scholar 

  29. Walker JL, Piedmonte MR, Spirtos NM et al (2012) Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group LAP2 study. J Clin Oncol 30:695–700

    Article  Google Scholar 

  30. How JA, O’Farrell P, Amajoud Z et al (2018) Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis. Minerva Obstet Gynecol. https://doi.org/10.23736/S0026-4784.17.04179-X

    Article  Google Scholar 

  31. Carter J, Huang HQ, Armer J et al (2020) GOG 244—the lymphedema and gynecologic cancer (LeG) study: the impact of lower-extremity lymphedema on quality of life, psychological adjustment, physical disability, and function. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2020.10.023

    Article  PubMed  PubMed Central  Google Scholar 

  32. de Boer SM, Powell ME, Mileshkin L et al (2018) Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 19:295–309

    Article  Google Scholar 

  33. Leitao MM, Zhou QC, Gomez-Hidalgo NR et al (2020) Patient-reported outcomes after surgery for endometrial carcinoma: prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy. Gynecol Oncol 156:147–153

    Article  Google Scholar 

  34. Geppert B, Lönnerfors C, Bollino M et al (2018) Sentinel lymph node biopsy in endometrial cancer-feasibility, safety and lymphatic complications. Gynecol Oncol 148:491–498

    Article  Google Scholar 

  35. Obermair HM, O’Hara M, Obermair A et al (2021) Paucity of data evaluating patient centred outcomes following sentinel lymph node dissection in endometrial cancer: a systematic review. Gynecol Oncol Rep 36:100763

    Article  Google Scholar 

  36. Kitchener H et al (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  CAS  Google Scholar 

  37. Panici PB, Basile S, Maneschi F et al (2008) Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  Google Scholar 

  38. Multinu F, Ducie JA, Eriksson AGZ et al (2019) Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm. Gynecol Oncol 155:177–185

    Article  CAS  Google Scholar 

  39. Emons G, Steiner E (2018) S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom. Gynäkologe 51:996–999

    Article  Google Scholar 

  40. Ramirez PT, Frumovitz M, Pareja R et al (2018) Phase III randomized trial of laparoscopic or robotic versus abdominal radical hysterectomy in patients with early-stage cervical cancer: LACC Trial. Gynecol Oncol (Supplement 1). https://doi.org/10.1016/j.ygyno.2018.04.552

    Article  PubMed  PubMed Central  Google Scholar 

  41. Meixner C (2021) S3-Leitlinie Zervixkarzinom, S 301

    Google Scholar 

  42. Tillmann B (2005) Atlas der Anatomie des Menschen: mit Muskeltrainer ; neue Approbationsordnung. Springer, Berlin

    Google Scholar 

  43. Lécuru F, Mathevet P, Querleu D et al (2011) Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol 29:1686–1691

    Article  Google Scholar 

  44. Mathevet P, Lecuru F, Magaud L et al (2017) Sentinel lymph node biopsy for early cervical cancer: results of a randomized prospective, multicenter study (Senticol 2) comparing adding pelvic lymph node dissection vs sentinel node biopsy only. Gynecol Oncol 145:2–3

    Article  Google Scholar 

  45. Altgassen C, Hertel H, Brandstädt A et al (2008) Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO study group. J Clin Oncol 26:2943–2951

    Article  Google Scholar 

  46. Lecuru FR, McCormack M, Hillemanns P et al (2019) SENTICOL III: an international validation study of sentinel node biopsy in early cervical cancer. A GINECO, ENGOT, GCIG and multicenter study. Int J Gynecol Cancer 29:829–834

    Article  Google Scholar 

  47. Cibula D, Dusek J, Jarkovsky J, Dundr P, Querleu D, van der Zee A, Kucukmetin A, Kocian R (2019) A prospective multicenter trial on sentinel lymph node biopsy in patients with early-stage cervical cancer (SENTIX). Int J Gynecol Cancer. https://doi.org/10.1136/ijgc-2018-000010

    Article  PubMed  PubMed Central  Google Scholar 

  48. Guani B, Balaya V, Magaud L et al (2020) The clinical impact of low-volume lymph nodal metastases in early-stage cervical cancer: the Senticol 1 and Senticol 2 trials. Cancers 12:1061

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Campus Lübeck, Klinik für Frauenheilkunde, Universitätsklinikum UKSH, Ratzeburger Allee 160, 23568, Lübeck, Deutschland

    Louisa Proppe,  Achim Rody &  Lars C. Hanker

Authors
  1. Louisa Proppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Achim Rody
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars C. Hanker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Louisa Proppe.

Ethics declarations

Interessenkonflikt

L. Proppe, A. Rody und L.C. Hanker geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Nicolai Maass, Kiel

Wolfgang Janni, Ulm

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Proppe, L., Rody, A. & Hanker, L.C. Lymphknotenstaging bei Genitalkarzinomen – wohin geht die Reise?. Gynäkologe 54, 868–874 (2021). https://doi.org/10.1007/s00129-021-04874-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-021-04874-6

Schlüsselwörter

Keywords

Search

Navigation