Der Chirurg

, Volume 77, Issue 11, pp 971–980 | Cite as

Staginglaparoskopie in der Onkologie

Leitthema

Zusammenfassung

Die zunehmende Differenzierung der viszeralen Tumortherapie setzt ein präzises und verlässliches Staging voraus, das trotz großer technischer Fortschritte durch die bildgebende Diagnostik nicht in allen Fällen gewährleistet wird. Die direkte visuelle Exploration des Bauchraums in der erweiterten diagnostischen Laparoskopie (EDL) mit gezielter Präparation primär nicht einsehbarer Areale inklusive Biopsieentnahme und die laparoskopische Ultraschalldiagnostik weist eine überlegene diagnostische Genauigkeit für den Nachweis/Ausschluss der frühen Peritonealkarzinose und (kleiner) Lebermetastasen auf und kann bei der Beurteilung des Lymphknotenstadiums und der lokalen Resektabilität hilfreich sein. Der prätherapeutische Einsatz der EDL ist beim Ösophaguskarzinom bei Vorliegen von fortgeschrittenen distalen Adenokarzinomen (AEG I nach Siewert) lohnend, während die Inzidenz von abdominalen Tumormetastasen beim Plattenepithelkarzinom im Allgemeinen zu gering ist, um eine EDL zu rechtfertigen. Beim fortgeschrittenen Magenkarzinom erbringt die EDL in mindestens einem Fünftel der Fälle therapierelevante Mehrinformationen, wenn ein neoadjuvantes Therapiekonzept geplant ist. Zumindest im Rahmen von Therapiestudien sollte deshalb derzeit noch die EDL obligat sein. Eine generelle Empfehlung der EDL beim Pankreaskarzinom wird heute von den meisten Arbeitsgruppen nicht mehr gegeben. Dagegen gewinnt der selektive Einsatz (fortgeschrittenes Tumorstadium mit hoher Wahrscheinlichkeit der Irresektabilität usw.) immer mehr Bedeutung. Bei hepatobiliären Malignomen und bei kolorektalen Lebermetastasen wurde auch in neueren Studien der hohe zusätzliche Informationsgewinn durch die EDL bestätigt.

Schlüsselwörter

Erweiterte diagnostische Laparoskopie Magenkarzinom Ösophaguskarzinom Lebertumoren Pankreaskarzinom Staging 

Staging laparoscopy in oncology

Abstract

The availability of more treatment options for gastrointestinal cancer requires precise and reliable pretherapeutic staging. Despite impressive technical progress in modern imaging procedures, this high level of staging quality is not yet warranted in all instances. Visual exploration of the abdominal cavity in extended diagnostic laparoscopy (EDL), including surgical dissection of areas which are primarily inaccessible, biopsy retrieval, and laparoscopic ultrasound, is superior in the diagnostic workup of early peritoneal carcinomatosis and (small) liver metastases. It is helpful to evaluate lymph node infliction and local resectability. In esophageal carcinoma, pretherapeutic EDL is valuable in case of advanced adenocarcinoma of the distal esophagus (AEG I according to Siewert), whereas the incidence of abdominal tumor manifestations in squamous cell carcinoma is too low to perform staging laparoscopy. In advanced gastric cancer, EDL yields relevant additional information in up to 20% of cases. If a multimodal therapeutic strategy is considered, EDL should be obligatory at least in prospective therapeutic studies. In carcinoma of the pancreas, EDL is in general not recommended by the majority of centers. Selective use (in particular in advanced cancer with a high probability of local irresectability) is gaining importance. In hepatobiliary malignancy including colorectal metastases, the high yield of additional information by EDL was confirmed in recent studies.

Keywords

Extended diagnostic laparoscopy Gastric cancer Esophageal cancer Hepatobiliary malignancies Pancreatic cancer Staging 
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Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Chirurgische Klinik und PoliklinikKlinikum rechts der Isar der TUMMünchenDeutschland

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