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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/01/12 17:14:55」(JST)

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Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes.^[1] It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.^[2]^[3]^[4]

Indications

It is usually done because many types of cancer have a marked tendency to produce lymph node metastasis early in their natural history. This is particularly true of melanoma, head and neck cancer, differentiated thyroid cancer, breast cancer, lung cancer, gastric cancer and colorectal cancer. Famed British surgeon Berkeley Moynihan once remarked that "the surgery of cancer is not the surgery of organs; it is the surgery of the lymphatic system".

The better-known examples of lymphadenectomy are axillary lymph node dissection for breast cancer; radical neck dissection for head and neck cancer and thyroid cancer; D2 lymphadenectomy for gastric cancer; and total mesorectal excision for rectal cancer.

With sentinel node biopsy

For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting sentinel node biopsy.^[5] Sentinel node biopsy can establish cancer staging of the axilla if there are positive lymph nodes present.^[5] It also is less risky than performing lymphadenectomy, having fewer side effects and a much lower chance of causing lymphedema.^[5] If cancer is not present in sentinel lymph nodes then the axillary lymph node dissection should not be performed.^[5]

If one or two sentinel nodes have cancer which is not extensive, then no axillary dissection should be performed but the person with cancer should have breast-conserving surgery and chemotherapy appropriate for their stage of cancer.^[5]

More recently, the concept of sentinel lymph node mapping has been popularized by Donald Morton and others. Cancer with various primary sites (breast, melanoma, colorectal, etc.) often metastasize early to the first drainage lymphatic basin. This process is predictable anatomically according to the primary site in the organ and the lymphatic channels. The first nodes (sentinel nodes) can be identified by particulate markers such as lymphazurin, methylene blue, India ink and radio-labelled colloid protein particles injected near the tumor site. The draining sentinel node can then be found by the surgeon and excised for verification by the pathologist if tumor cells are present, and often these tumor cells are few and only easily recognized by careful examination or by using techniques such as special stains, i.e. immunohistochemical. When the sentinel node is free of tumor cells, this is highly predictive of freedom from metastasis in the entire lymphatic basin, thus leading to futility of a full node dissection.

The practice of sentinel lymph node mapping has changed the surgical approach in many cancer systems, sparing a formal lymph node dissection for patients with sentinel lymph node negative for tumor and directing a full node dissection for patients with sentinel lymph node positive for tumor metastases. For example in stage II breast carcinoma, using the sentinel lymph node technique, 65% of patients could be spared from a formal node dissection.

Complications

Lymphedema may result from lymphadenectomy. Extensive resection of lymphatic tissue can lead to the formation of a lymphocele.

References

^ Wagman LD. "Principles of Surgical Oncology" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
^ "Lymph node dissection". NCI Dictionary of Cancer Terms. National Cancer Institute. Retrieved 30 July 2012.
^ "Lymphadenectomy". NCI Dictionary of Cancer Terms. National Cancer Institute. Retrieved 30 July 2012.
^ "Radical lymph node dissection". NCI Dictionary of Cancer Terms. National Cancer Institute. Retrieved 30 July 2012.
^ ^a ^b ^c ^d ^e American College of Surgeons (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American College of Surgeons), retrieved 2 January 2013 , which cites various primary research studies.

External links

Axillary Lymph Node Dissection - online learning resource

This article incorporates public domain material from the U.S. National Cancer Institute document "Dictionary of Cancer Terms".

UpToDate Contents

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English Journal

Aggressive variants of papillary thyroid cancer.

Roman S, Sosa JA.SourceDepartment of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Current opinion in oncology.Curr Opin Oncol.2013 Jan;25(1):33-8. doi: 10.1097/CCO.0b013e32835b7c6b.
PURPOSE OF REVIEW: Aggressive variants of papillary thyroid cancer (PTC) have been recognized with increasing frequency. The most common of these include the diffuse sclerosing variant, tall cell variant, and insular thyroid cancer. These tumors may represent a spectrum of dedifferentiation from cla
PMID 23197194

Management of microcarcinomas (papillary and medullary) of the thyroid.

Wu LS, Milan SA.SourceaDepartment of Surgery, Maine Medical Center, Portland, Maine bDepartment of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Current opinion in oncology.Curr Opin Oncol.2013 Jan;25(1):27-32. doi: 10.1097/CCO.0b013e328359feea.
PURPOSE OF REVIEW: Microcarcinomas of the thyroid gland are defined by the size criteria as tumors measuring less than 1 cm in greatest dimension. The clinical significance of papillary thyroid microcarcinoma (PTMC) and medullary thyroid microcarcinoma (MTMC) is debatable. Variation in practice pa
PMID 23042124

Japanese Journal

Successful salvage lymphadenectomy after stent grafting for aortic lymph node recurrence of thoracic esophageal carcinoma : a first case report

Shibata Tomotaka,Noguchi Tsuyoshi,Etoh Tsuyoshi [他]
Esophagus : official journal of the Japan Esophageal Society 12(3), 312-315, 2015-07
NAID 40020539796

S字皮膚切開を用いて鼠径リンパ節郭清術を施行した陰茎癌の1例

角田俊雄,白戸玲臣,大野愼介 [他]
西日本泌尿器科 = The Nishinihon journal of urology 77(5), 169-173, 2015-05
NAID 40020465420

症例報告腋窩リンパ節転移で発見され胸筋温存乳房切除術を施行した潜在性乳癌の2例

深光岳,野島真治,杉山望 [他],金田好和,須藤隆一郎,亀井敏昭
山口医学 = Yamaguchi medical journal 64(2), 153-157, 2015-05
… She was diagnosed with latent breast cancer and underwent mastectomy and axillary lymphadenectomy. … She underwent mastectomy and axillary lymphadenectomy. …
NAID 120005617817

Related Pictures

★リンクテーブル★

リンク元	「リンパ節切除術」「リンパ節切除」「lymph node excision」「リンパ節郭清術」
拡張検索	「infraclavicular lymphadenectomy」「supraclavicular lymphadenectomy」「pelvic lymphadenectomy」