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R1-Resektion beim Ösophaguskarzinom

R1 resection of esophageal carcinoma

Zusammenfassung

Die mikroskopische Identifikation von residuellem Tumor im Bereich des oralen oder aboralen Resektionsrandes im Resektat nach onkologischer Ösophagusresektion beim Ösophaguskarzinom (R1-Resektion) erhöht das Rezidivrisiko und die krankheitsbezogene Mortalität. Die Ösophagusresektion mit assoziierten Risiken macht somit nur Sinn, wenn sicher eine R0-Situation erzielt werden kann. Die Relevanz des mikroskopischen Befalls des „circumferential resection margin“ (CRM) beim Ösophaguskarzinom in seinen unterschiedlichen Definitionen der britischen und der amerikanischen Gesellschaft für Pathologie wurde bisher in keiner prospektiven Studie untersucht. Gemäß deutscher S3-Leitlinie sollte bei postoperativ nachgewiesener R1-Situation, die nicht durch eine kurative Nachresektion in eine R0-Situation zu konvertieren ist, bzw. bei ungünstigen Bedingungen für eine Nachresektion unabhängig von einer neoadjuvanten Therapie eine Radiochemotherapie erfolgen. Liegt eine R1-Situation im Bereich des CRM vor, ist aufgrund der anatomischen Gegebenheiten mit entsprechenden Limitierungen durch Aorta und Wirbelsäule eine Nachresektion nicht einfach möglich im Gegensatz zu Ausweitungen der Resektionen nach oral oder aboral.

Abstract

The microscopic identification of residual tumor tissue in the oral or aboral resection margins (R1 resection) of esophageal specimens following oncologic esophageal resection, increases the risk of tumor recurrence and disease-related morbidity. Esophageal resection with its associated risks is only meaningful, if an R0 situation can be safely achieved. The relevance of microscopic involvement of the circumferential resection margin (CRM) in esophageal carcinoma in its different definitions by the British and the American Societies of Pathology has up to now never been investigated in a prospective study. According to the German S3 guideline, radiochemotherapy should be performed in a postoperatively proven R1 situation, which cannot be converted by a curative extended re-resection into an R0 situation or in unfavorable conditions for an extended re-resection, independent of neoadjuvant therapy. In the case of an R1 situation in the region of the CRM, an extended re-resection is not simply possible on account of the anatomical conditions with corresponding limitations by the aorta and the spinal column, in contrast to extensions of the re-resection orally or aborally.

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Correspondence to I. Gockel MBA.

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I. Gockel und C. Wittekind geben an, dass kein Interessenkonflikt besteht.

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

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Gockel, I., Wittekind, C. R1-Resektion beim Ösophaguskarzinom. Chirurg 88, 748–755 (2017). https://doi.org/10.1007/s00104-017-0469-1

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Schlüsselwörter

  • Ösophagektomie
  • Nachresektion
  • Radiochemotherapie
  • Lokalrezidiv
  • Prognose

Keywords

  • Esophagectomy
  • Re-resection
  • Radiochemotherapy
  • Local recurrence
  • Prognosis