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Chirurgische Therapie gastroduodenaler neuroendokriner Neoplasien

Surgical approach of gastroduodenal neuroendocrine neoplasms

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Zusammenfassung

Gastroduodenale neuroendokrine Neoplasien (NEN) haben in den letzten 35 Jahren an Häufigkeit zugenommen. Zeitgleich hat sich auch die Prognose der Patienten wesentlich verbessert, da die Mehrzahl dieser Tumoren heute in einem frühen Stadium festgestellt wird. NEN des Magens sind die häufigsten Neoplasien neuroendokrinen Ursprungs im Gastrointestinaltrakt. In der Diagnostik nehmen sie eine Sonderstellung ein, da neben dem Staging und Grading unterschiedliche pathophysiologische Grundlagen (Typen) für die Einteilung herangezogen werden können. Diese unterscheiden sich in ihrem biologischen Verhalten und beeinflussen damit die Therapiekonzepte. Da über 90 % der duodenalen NEN asymptomatisch sind und in der Regel auch in einem kurativen Stadium entdeckt werden, ist stets die Resektion des Tumors anzustreben. Die Möglichkeiten der Resektion reichen von lokalen endoskopischen Verfahren über lokale chirurgische Verfahren (Duodenotomie mit Exzision) bis hin zur pankreaserhaltenden Duodenektomie oder pyloruserhaltenden bzw. klassischen Whipple-Operation. In diesem Beitrag werden die verschiedenen chirurgischen Therapieansätze vorgestellt.

Abstract

Gastroduodenal neuroendocrine tumors are rare but an increase in incidence has been recognized worldwide over the past 35 years. At the same time the prognosis of patients has substantially improved because the majority of these tumors can now be detected at an early stage. Neuroendocrine neoplasms (NENs) of the stomach are the most frequent neoplasms of neuroendocrine origin in the gastrointestinal tract. The therapeutic management of these tumors is complicated by the fact that they must be classified not only by staging and grading but also according to their pathophysiological background (types). These types differ in biological behavior and therefore have an influence on the therapeutic concept. Because more than 90 % of duodenal NENs are often asymptomatic and are as a rule identified at a curable stage, resection of the tumor should always be the first line of therapy. The therapeutic strategies vary from local endoscopic resection (duodenotomy with excision) up to pancreas retaining duodenectomy and pylorus retaining or classical Whipple procedures. This article presents the various surgical approaches to gastric and duodenal NENs.

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Authors and Affiliations

  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    V. Fendrich & D. K. Bartsch

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Correspondence to V. Fendrich.

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V. Fendrich und D. K. Bartsch geben an, dass kein Interessenkonflikt besteht.

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Fendrich, V., Bartsch, D.K. Chirurgische Therapie gastroduodenaler neuroendokriner Neoplasien. Chirurg 87, 280–287 (2016). https://doi.org/10.1007/s00104-015-0138-1

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