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Aktuelle S3-Leitlinie zur Chirurgie des Magenkarzinoms

Current S3 guidelines on surgical treatment of gastric carcinoma

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Zusammenfassung

Die aktuelle S3-Leitlinie zur Diagnostik und Therapie des Magenkarzinoms einschließlich der Adenokarzinome des ösophagogastralen Übergangs beschreibt die bestmöglichen Versorgungsmodalitäten basierend auf hoher Evidenz und interdisziplinärem Konsens verschiedener medizinischer Fachgebiete. Die Ösophagogastroduodenoskopie mit Entnahme multipler Biopsien ist als Standardverfahren zur Detektion von Tumoren im oberen Gastrointestinaltrakt anzusehen. Zum Staging werden weitere bildgebende Untersuchungsverfahren eingesetzt. Die Chirurgie stellt weiterhin bis auf die mukosabeschränkten Tumoren die entscheidende Behandlungsoption mit kurativem Ansatz bei allen potenziell resezierbaren Stadien dar. Beim lokal fortgeschrittenen Karzinom (ab uT3) soll oder sollte die perioperative Chemotherapie durchgeführt werden, beim Kardia- und subkardialen Karzinom alternativ auch eine präoperative Strahlen-Chemo-Therapie. Im metastasierten, asymptomatischen Stadium stellt die palliative Resektion eine Ausnahmeindikation dar. Bei tumorbedingten Komplikationen sollten in der Palliativsituation bevorzugt interventionelle oder konservative Maßnahmen zum Einsatz kommen.

Abstract

The current S3 guidelines on the diagnosis and treatment of gastric carcinoma including those of the esophagogastric junction describe optimal clinical practice based on a high level of evidence and expert consensus from different medical disciplines. Endoscopy and performance of multiple biopsies is the standard approach to detect malignant tumors in the upper gastrointestinal tract. Further diagnostic procedures are necessary to evaluate the tumor stage. With the exception of mucosal carcinomas, surgical therapy is the cornerstone of curative treatment in all potentially resectable stages. In locally advanced carcinomas perioperative chemotherapy should be carried out and in high-seated tumors preoperative radiochemotherapy might be an alternative option. Palliative surgical resection should be avoided in disseminated asymptomatic stages. In a palliative situation complications of the tumor should primarily be treated by interventional or conservative procedures.

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Authors and Affiliations

  1. Klinik für Allgemein und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Gotenstraße 1, 42653, Solingen, Deutschland

    H.-J. Meyer

  2. Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Köln, Deutschland

    A.H. Hölscher & S. Mönig

  3. Medizinische Klinik III – Hämatologie und Onkologie, Klinikum Braunschweig, Braunschweig, Deutschland

    F. Lordick

  4. III. Medizinische Klinik, Klinikum Augsburg, Augsburg, Deutschland

    H. Messmann

  5. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar (TUM), München, Deutschland

    C. Schumacher

  6. Zentrum für Internistische Onkologie/Hämatologie, Kliniken Essen Mitte, Essen, Deutschland

    M. Stahl & H. Wilke

  7. I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland

    M. Möhler

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  1. H.-J. Meyer
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  2. A.H. Hölscher
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  3. F. Lordick
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  4. H. Messmann
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  5. S. Mönig
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  6. C. Schumacher
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  7. M. Stahl
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  8. H. Wilke
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  9. M. Möhler
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Correspondence to H.-J. Meyer.

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Meyer, HJ., Hölscher, A., Lordick, F. et al. Aktuelle S3-Leitlinie zur Chirurgie des Magenkarzinoms. Chirurg 83, 31–37 (2012). https://doi.org/10.1007/s00104-011-2149-x

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  • DOI: https://doi.org/10.1007/s00104-011-2149-x

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