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Laparoskopische vs. offene Gastrektomie bei fortgeschrittenem Magenkarzinom

Operative und postoperative Ergebnisse

Laparoscopic versus open gastrectomy for advanced gastric cancer

Operative and postoperative results

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Zusammenfassung

Hintergrund

Die minimal-invasive Gastrektomie etabliert sich weltweit zunehmend als Alternative zur offenen Gastrektomie (OG). Die Mehrzahl der hierzu verfügbaren Literatur bezieht sich jedoch auf die asiatische Population und auf frühe Stadien des Magenkarzinoms, wobei ein internationaler Vergleich der Ergebnisse aufgrund einer Diskrepanz der Patientenpopulationen, der Tumorbiologie und auch der Therapieansätze zwischen asiatischer und westlicher Welt schwierig ist. Wenig ist daher darüber bekannt, ob die laparoskopische Gastrektomie (LG) auch bei fortgeschrittenem Karzinom insbesondere hinsichtlich laparoskopischer D2-Lymphadenektomie hierzulande mit ausreichender Radikalität und Sicherheit durchführbar ist.

Material und Methoden

Es erfolgte die Analyse aller durchgeführten Gastrektomien zur Therapie eines fortgeschrittenen Magenkarzinoms im klinischen UICC-Stadium 2 und 3 zwischen 2005 und 2017. Zum Vergleich der operativen und früh-postoperativen Ergebnisse nach laparoskopischer und offener Gastrektomie erfolgte ein „case-matching“ nach Alter, Geschlecht und UICC-Stadium.

Ergebnisse

Insgesamt wurden 243 Patienten aufgrund eines fortgeschrittenen Magenkarzinoms eingeschlossen und analysiert. Hiervon erfolgte bei 81 Patienten (33,3 %) eine LG. Die Operationszeit der LG war im Mittel 74 min länger (279,2 vs. 353,4 min; OG vs. LG; p < 0,001), der stationäre Aufenthalt nach LG etwa 4 Tage kürzer (22,9 vs. 18,4 Tage; OG vs. LG; p < 0,001). Bei der LG wurden signifikant mehr Lymphknoten reseziert (24,1 vs. 28,8 Lymphknoten; OG vs. LG; p < 0,001). In Bezug auf die Morbidität und Mortalität zeigte sich kein Unterschied in den Operationsgruppen.

Schlussfolgerung

Die vorliegende Studie zeigt, dass die minimal-invasive Gastrektomie auch bei fortgeschrittenem Magenkarzinom bei westlicher Bevölkerung technisch sicher und mit vergleichbaren histopathologischen Ergebnissen zur offenen Operation durchgeführt werden kann. Größere Fallzahlen und Evidenz aus hochwertigen Studien hierzu sind jedoch insbesondere zur Beurteilung der Überlebensunterschiede dringend erforderlich.

Abstract

Background

Minimally invasive gastrectomy is increasingly becoming established worldwide as an alternative to open gastrectomy (OG); however, the majority of available articles in the literature refer to Asian populations and early stages of gastric cancer. This makes an international comparison difficult due to a discrepancy in patient populations and tumor biology as well as Asian and western treatment approaches. Little is known, therefore, whether laparoscopic gastrectomy (LG) can be performed in advanced cancer, in particular with respect to laparoscopic D2 lymphadenectomy, with sufficient radicality and safety in this country.

Material and methods

All gastrectomies performed for the treatment of advanced gastric cancer with clinical UICC stages 2 and 3 between 2005 and 2017 were analyzed. A case match by age, gender and UICC stage was performed to compare the operative and early postoperative results of LG and OG.

Results

A total of 243 patients with advanced gastric cancer were analyzed. Of these 81 patients (33.3%) underwent LG. The operative time for LG was around 74 min longer (279.2 min vs. 353.4 min, OG vs. LG; p < 0.001), the hospital stay after LG was around 4 days shorter (22.9 days vs. 18.4 days, OG vs. LG; p < 0.001). Significantly more lymph nodes were resected by LG (24.1 lymph nodes vs. 28.8 lymph nodes, OG vs. LG; p < 0.001). In terms of morbidity and mortality there were no differences between the groups.

Conclusion

The present study showed that minimally invasive gastrectomy can be performed safely and with comparable histopathological results to open surgery, even in advanced gastric cancer in western populations; however, larger case series and evidence from high-quality studies are urgently needed especially to compare short-term and long-term survival.

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Authors and Affiliations

  1. Chirurgische Klinik, Charité – Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Mitte, Charité Campus Virchow, Charitéplatz 1, 10117, Berlin, Deutschland

    J. Raakow, C. Denecke, S. Chopra, T. Hofmann, A. Andreou, J. Pratschke &  M. Biebl

  2. Department für Medizinische Statistik, Informatik und Gesundheitsökonomie, Medizinische Universität Innsbruck, Schöpfstraße 41/1, 6020, Innsbruck, Österreich

    J. Fritz

  3. Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité – Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    P. Thuss-Patience

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  1. J. Raakow
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Correspondence to M. Biebl.

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J. Raakow, C. Denecke, S. Chopra, J. Fritz, T. Hofmann, A. Andreou, P. Thuss-Patience, J. Pratschke und M. Biebl geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Die Autoren J. Raakow und C. Denecke haben zu gleichen Teilen zu der Arbeit beigetragen.

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Raakow, J., Denecke, C., Chopra, S. et al. Laparoskopische vs. offene Gastrektomie bei fortgeschrittenem Magenkarzinom. Chirurg 91, 252–261 (2020). https://doi.org/10.1007/s00104-019-01053-1

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