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Minimal-invasive Magenchirurgie

Minimally invasive gastric surgery

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Zusammenfassung

In den letzten Jahren hat das Interesse am Einsatz der minimal-invasiven Chirurgie (MIC) beim Magenkarzinom weltweit zugenommen. Insbesondere im Zusammenhang mit distalen Magenresektionen bei Magenfrühkarzinomen liegen inzwischen eine Reihe prospektiv randomisierter und retrospektiver Studien zum Vergleich von MIC und offener Chirurgie vor. In diesen Studien konnte bei vergleichbarer Letalität ein Vorteil für die laparoskopische Technik im Hinblick auf eine Senkung der Morbidität, weniger Schmerzen, eine schnellere postoperative Erholung und eine kürzere stationäre Verweildauer nachgewiesen werden. Aktuell sind jedoch nur wenige Daten zum onkologischen Langzeitverlauf verfügbar, sodass gegenwärtig noch eine gewisse Zurückhaltung beim Einsatz der MIC besteht. Für den Sonderfall eines endoskopisch nichtresezierbaren mukosalen Frühkarzinoms können laparoskopische Wedge- oder intragastrale Resektionen eine Alternative darstellen, wobei für diese Verfahren im Langzeitverlauf akzeptable Überlebens- und niedrige Rezidivraten nachgewiesen wurden.

Im Hinblick auf die laparoskopische totale Gastrektomie bzw. den Einsatz der MIC bei fortgeschrittenen Magenkarzinomen konnte gezeigt werden, dass eine adäquate onkologische Resektion und Lymphknotendissektion technisch durchführbar sind. Allerdings werden selbst in ausgewiesenen Zentren für die komplexere laparoskopische totale Gastrektomie höhere Komplikationsraten sowie eine Erhöhung der postoperativen Morbidität im Vergleich zur distalen Magenresektion registriert.

Abstract

The interest in minimally invasive surgery (MIS) for the treatment of gastric carcinoma has increased in recent years worldwide. In particular, for early gastric carcinoma (EGC) many retrospective comparative trials and some prospective randomized trials have confirmed that laparoscopy-assisted distal gastrectomy shows a better short-term outcome in terms of lower morbidity, less pain, faster recovery and shorter hospital stay in contrast to open surgery. In this group of selected patients MIS is safe and feasible but at present not widely accepted because of a limited evaluation in oncologic long-term follow-up. In cases of EGC limited to the mucosal layer and under the condition that endoscopic resection is not suitable, laparoscopic local wedge resection or intragastric resection can be an alternative option with good results in long-term follow-up.

The data for laparoscopic total gastrectomy and MIS for advanced gastric cancer have confirmed that both are technically feasible and extended lymph node dissection can also be laparoscopically performed. However, laparoscopic total gastrectomy is much more complex and even in expert hands more complications and a higher morbidity have been observed in contrast to laparoscopic distal resections.

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  1. Klinik für Chirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland

    K. Ludwig, U. Scharlau, S. Schneider-Koriath & J. Bernhardt

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  1. K. Ludwig
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  2. U. Scharlau
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  3. S. Schneider-Koriath
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  4. J. Bernhardt
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Correspondence to K. Ludwig.

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Ludwig, K., Scharlau, U., Schneider-Koriath, S. et al. Minimal-invasive Magenchirurgie. Chirurg 83, 16–22 (2012). https://doi.org/10.1007/s00104-011-2148-y

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