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Therapieempfehlungen beim Frühkarzinom des Ösophagus

Endoskopische und chirurgische Optionen

Treatment recommendations for early esophageal cancer

Endoscopic and surgical options

Zusammenfassung

Hintergrund

Das Ösophaguskarzinom stellt eine komplexe Tumorentität dar mit steigendem Anteil an Adenokarzinomen. Bei Frühkarzinomen wird anhand der Tiefeninfiltration der Mukosa in m1- bis m3- bzw. der Submukosa in sm1- bis sm3-Tumoren unterteilt. Das Risiko von Lymphknotenmetastasen korreliert stark mit der Tiefeninvasion und steigt mit Infiltration der Submukosa sprunghaft an.

Material und Methoden

Die Autoren führten eine selektive Literaturrecherche (MEDLINE, PubMed, Cochrane Library, International Standard Randomised Controlled Trial Number [ISRCTN] Registry) zum aktuellen Management beim Ösophagusfrühkarzinom durch.

Ergebnisse

Die endoskopische Diagnostik und Dignitätsbeurteilung oberflächlicher Ösophaguskarzinome ist um die virtuelle Chromoendoskopie zu den bisherigen Färbetechniken erweitert worden. Die endoskopische Resektion ist das diagnostische und therapeutische Verfahren der Wahl bei mukosalen Adenokarzinomen mit niedrigem Risiko (Grading 1 oder 2, keine Blut‑/Lymphgefäßinvasion). Unter speziellen Voraussetzungen können auch Adenokarzinome der oberen Submukosa (sm1) endoskopisch abgetragen werden. Alle weiteren Stadien bedürfen einer chirurgischen Therapie. Beim Plattenepithelkarzinom ohne Risikofaktoren ist ab einer Infiltration der 3. Mukosaschicht (m3) die chirurgisch-onkologische Ösophagusresektion indiziert. Die endoskopische Submukosadissektion (ESD) weist selbst bei großen Läsionen hohe Raten an En-bloc- und R0-Resektionen auf.

Schlussfolgerung

Grenzfälle zwischen endoskopischer und chirurgischer Therapie von Ösophagusfrühkarzinomen benötigen einen interdisziplinären Ansatz und individuell angepasste Strategien, welche im lokal fortgeschrittenen Stadium immer in ein multimodales Konzept eingebettet sind.

Abstract

Background

Esophageal cancer represents a complex tumor entity with an increasing proportion of adenocarcinomas. Early esophageal cancer is staged as m1–m3 depending on the depth of infiltration into the mucosa and as sm1–sm3 depending on invasion into the submucosa. The risk of lymph node metastasis is strongly correlated with the depth of invasion and increases by leaps and bounds with submucosal infiltration.

Material and methods

This review is based on publications retrieved by a selective database search (MEDLINE, PubMed, Cochrane Library, International Standard Randomised Controlled Trial Number, ISRCTN, registry) on the current management of early esophageal cancer.

Results

The endoscopic diagnostics and evaluation of the dignity of superficial esophageal cancer by traditional staining techniques have been expanded by virtual chromoendoscopy. Endoscopic resection is the diagnostic and therapeutic procedure of choice for mucosal low risk adenocarcinomas (grade 1 or 2, no blood or lymph vessel invasion). Under certain prerequisites adenocarcinomas of the upper submucosa (sm1) can also be endoscopically removed. All other stages necessitate surgical treatment. In squamous cell carcinoma without risk factors a surgical oncological esophageal resection is indicated after infiltration of the third mucosal layer (m3). Endoscopic submucosal dissection (ESD) shows high rates of en bloc and R0 (curative) resections even with large lesions.

Conclusion

Borderline cases between endoscopic and surgical treatment of early esophageal cancer necessitate an interdisciplinary approach and individually adapted management, which in the locally advanced stage are always embedded in a multimodal concept.

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Danksagung

Vielen Dank an Klaus Kraywinkel (Robert-Koch-Institut) für die Aufarbeitung und Übermittlung der Krebsregisterdaten zum Ösophaguskarzinom in Deutschland.

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Correspondence to I. Gockel MBA.

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Interessenkonflikt

T. Schlosser, A. Hoffmeister, J. Feisthammel, S. Niebisch, R. Thieme und I. Gockel 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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Schlosser, T., Hoffmeister, A., Feisthammel, J. et al. Therapieempfehlungen beim Frühkarzinom des Ösophagus. Chirurg (2021). https://doi.org/10.1007/s00104-021-01513-7

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Schlüsselwörter

  • Oberflächliches Ösophaguskarzinom
  • Endoskopische Mukosaresektion
  • Endoskopische Submukosadissektion
  • Chirurgische Therapie
  • Ösophagektomie

Keywords

  • Superficial esophageal neoplasm
  • Endoscopic mucosal resection
  • Endoscopic submucosal dissection
  • Surgical treatment
  • Esophagectomy