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Resektion beim fortgeschrittenen Adenokarzinom des Magens und des Ösophagus

Erweiterung der Indikation

Resection of advanced esophagogastric adenocarcinoma

Extended indications

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Zusammenfassung

In den aktuell gültigen deutschen S3-Leitlinien wird bei metastasierten Magenkarzinomen und metastasierten Adenokarzinomen des ösophagogastralen Übergangs eine chirurgische Therapie in der Regel nicht empfohlen. In der täglichen Praxis findet jedoch schon heute in Einzelfällen eine Erweiterung der Indikation statt, sodass auch solche Patienten in kurativer Zielsetzung im Rahmen eines multimodalen Therapiekonzepts ausgedehnt und radikal operiert werden. Diese Arbeit stellt die wissenschaftliche Rationale eines solchen Vorgehens anhand der vorliegenden Literatur und unter Einbeziehung moderner, multimodaler Konzepte dar und verweist auf Kriterien, die für eine Erweiterung der Indikation gegeben sein sollten. Bislang existieren lediglich retrospektive Untersuchungen und wenige aktuelle Metaanalysen, die eine chirurgische Behandlung bei metastasierten Adenokarzinomen rechtfertigen. Es liegen zudem erste Ergebnisse der als Abstract publizierten FLOT-3-Studie vor, die eine Patientensubgruppe identifizieren konnte, die von einer Resektion im metastasierten Stadium profitiert. Ob die chirurgische Therapie zukünftig ein fester Bestandteil in der Behandlung des begrenzt metastasierten Adenokarzinoms des Magens und des Ösophagus wird, müssen große prospektiv randomisierte Studien wie die RENAISSANCE/FLOT-5-Studie zeigen.

Abstract

In the current German S3 guidelines surgical treatment is not recommended for metastatic gastric cancer or metastatic adenocarcinoma of the esophagogastric junction; however, in routine practice the indications can be extended so that there may be occasions in which radical surgical intervention for specific individuals may be appropriate as part of a multimodal therapy with curative intent. This article presents the scientific rationale of such an approach based on the available literature considering modern, multimodal therapy concepts including criteria to be met for radical surgery. Currently only retrospective trials and limited current meta-analysis data are available for justifying surgical treatment for metastatic adenocarcinoma. The recently published initial results of the FLOT-3 study identified a patient subgroup that benefits from a resection even though metastasis has occurred. Whether surgical therapy will become an integral part of the treatment of limited metastatic adenocarcinoma of the stomach and esophagus in the future, has to be demonstrated by large prospective randomized studies, such as the RENAISSANCE/FLOT-5 study.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    S. P. Mönig &  L. M. Schiffmann

  2. Service de Chirurgie viscéral, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland

    S. P. Mönig

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Correspondence to S. P. Mönig.

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Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Mönig, S.P., Schiffmann, L.M. Resektion beim fortgeschrittenen Adenokarzinom des Magens und des Ösophagus. Chirurg 87, 398–405 (2016). https://doi.org/10.1007/s00104-016-0183-4

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