Pilotstudie zur Etablierung einer standardisierten Lymphadenektomie beim Nebennierenrindenkarzinom

The adrenocortical carcinoma is a rare malignant disease with an overall unfavorable prognosis. The 5-year survival rate is between 16% and 44%. At time of diagnosis, about half of all pa-tients have an advanced tumor stadium. Complete surgical resection with lymphadenectomy is currently the only curative approach. Despite R0 resection, recurrences are frequent. Recurrence rates vary from 21-91%. In 19%-60% of the cases these are locoregional metastases. For other tumor entities, a number of lymph nodes have been determined on the basis of anatomical stud-ies and histopathological evaluation, which have to be removed in the course of oncological re-section. For ACC this has yet to be thoroughly evaluated. Currently, it is recommended to re-move five lymph nodes within the scope of resection. This study is intended to give an indication of the possible number and distribution of lymph nodes in the lymphatic drainage area of the adrenal gland. Based on anatomical studies of the adrenal lymph drainage area, 8 compartments were defined. Subsequently, the corresponding compartments of 20 cadavers were removed and histopathological evaluated. In total, between 8 and 34 lymph nodes were removed (median 20). In the side-separated analysis, lymph nodes could be removed for the right side 1-24 (median 8). For the left side 8-25 (median 15) lymph nodes were collected. The majority of lymph nodes were collected from compartments II, IV, VI and VII. The compartments containing the upper renal capsule did not show any lymph nodes. Furthermore all available surgical reports and histopathological reports of the patients undergoing an adrenalectomy due to ACC were reviewed retrospectively for a possible lym-phadenectomy in Marburg from 1997 to 2016. In 17 of 36 patients lymph nodes were removed, which corresponds to a lymphadenectomy rate of 47,2%. Between 1 and 29 lymph nodes (me-dian 3) were removed. In only three of 17 patients the lymph node yield was five or more, which corresponds to a lymphadenectomy rate of 8,3% according to the definition of Reibetanz et al.. One patient underwent a systematic lymphadenectomy according to the defined compart-ments. Here 29 lymph nodes were resected, 18 of which already showed lymph node metasta-ses. Based on the data collected in this study, lymphadenectomy should be given a higher priority during primary tumor resection. The influence on local recurrence rate and overall survival should be evaluated in subsequent randomized prospective studies.