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Der Chirurg

, Volume 88, Issue 12, pp 1005–1009 | Cite as

Chirurgische Strategie in der multimodalen Behandlung des Magen- und Ösophaguskarzinoms

  • J. Hoeppner
Leitthema
  • 569 Downloads

Zusammenfassung

Der Großteil der kurativ behandelbaren Ösophagus- und Magenkarzinome wird in Westeuropa aktuell im lokal fortgeschrittenen Stadium diagnostiziert. Die überwiegende Mehrheit dieser Patienten in Westeuropa und den USA wird heute im Rahmen multimodaler Therapieprotokolle behandelt. Diese Protokolle bestehen aus einer neoadjuvant radiochemotherapeutischen oder einer perioperativ chemotherapeutischen Komponente und der radikalen chirurgischen Resektion inklusive Lymphadenektomie. Die Ösophagusresektion bzw. Gastrektomie sind hierbei weiter der zentrale kurative Therapiebestandteil. Die aktuellen chirurgischen Therapieempfehlungen und Leitlinien wurden allerdings anhand von Erfahrungen und Studien aus nahezu ausschließlich unimodal chirurgisch behandelten Patientenkollektiven formuliert. Die Gültigkeit für die heute vor allem multimodal behandelten Patienten muss daher dringend überprüft werden. Insbesondere gibt es dabei aus aktuellen Studien Ergebnisse und indirekte Hinweise, die zwischen der unimodal chirurgischen Therapie und der multimodalen Therapie einen Unterschied in Hinblick auf die Wirksamkeit der radikalen Lymphadenektomie auf die onkologischen Ergebnisse zeigen. Vor dem Hintergrund dieser Arbeiten stellt sich die Frage, ob es unter dem Einfluss der zusätzlichen Therapiemodalitäten möglich ist, die chirurgische Resektion dem multimodalen Gesamtkonzept anzupassen. Zukünftige prospektiv-randomisierte chirurgische Studien sollten eine für die multimodalen Therapiekonzepte maßgeschneiderte Anpassung der Radikalität am Zielorgan und im lokoregionären Tumorausbreitungskompartiment zum Ziel haben. Hierbei müssen auch die unterschiedlichen histologischen Tumorentitäten am oberen Gastrointestinaltrakt mit einbezogen werden.

Schlüsselwörter

Lymphadenektomie Gastrektomie  Chirurgie Chemotherapie Radiochemotherapie 

Surgical strategy in multimodal treatment of gastric and esophageal cancer

Abstract

The majority of curatively treatable esophageal and gastric carcinomas are currently diagnosed in a locally advanced stage in Western Europe. The vast majority of patients in Western Europe and the USA are now treated in multimodal treatment protocols. These protocols consist of neoadjuvant chemoradiation or perioperative chemotherapy plus radical surgical resection including lymphadenectomy. Radical esophagectomy and gastrectomy are still the main curative therapeutic step in these  multimodal protocols. The current surgical recommendations and guidelines were, however, based on experience and studies from almost exclusively unimodal treatment of patient groups. The validity for the patients, particularly those who undergo multimodal treatment, therefore urgently needs to be reviewed. In particular, there are results and indirect indications from recent studies that show a difference between unimodal surgical therapy and multimodal therapy in the efficacy of radical lymphadenectomy on the oncological results. Against the background of these studies, the question arises whether it is possible to adapt surgical resection to the multimodal overall concept under the influence of the additional therapeutic modalities. Future prospective randomized surgical trials should have a tailor-made adaptation to the multimodal therapy concepts concerning primary tumor and locoregional tumor compartments. The different histological tumor entities of the upper gastrointestinal tract must also be included.

Keywords

Lymphadenectomy Gastrectomy Surgery Chemotherapy Chemoradiotherapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Hoeppner gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Allgemein- und ViszeralchirurgieUniversitätsklinikum FreiburgFreiburgDeutschland
  2. 2.Medizinische FakultätAlbert-Ludwigs-Universität FreiburgFreiburgDeutschland

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