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Komplette Response nach neoadjuvanter Therapie beim Magenkarzinom: Implikationen für die Chirurgie

Complete response after neoadjuvant therapy for gastric cancer: implications for surgery

Zusammenfassung

Hintergrund

Die perioperative oder neoadjuvante Therapie ist in Europa die tragende Säule der Behandlung des lokal fortgeschrittenen Magenkarzinoms, jedoch fehlen Daten für eine mögliche Anpassung der chirurgischen Strategie in Abhängigkeit des Ansprechens auf die präoperative Behandlung.

Methoden

Dieses Review erfolgte auf Basis einer Recherche der relevanten aktuellen wissenschaftlichen Literatur zur neoadjuvanten oder perioperativen Behandlung des Adenokarzinoms des Magens und Implikation des Tumoransprechens auf die nachfolgende chirurgische Behandlung.

Ergebnisse

Die aktuellen randomisierten Studien zeigen einen Überlebensvorteil nach perioperativer bzw. neoadjuvanter Behandlung des Magenkarzinoms. Aufgrund des unterschiedlichen Ansprechens auf den präoperativ verabreichten Teil der Therapie, inklusive „complete response“, liegt es nahe, einen individuellen chirurgischen Ansatz zu entwickeln. Allerdings ist die Aussagekraft der Ergebnisse aufgrund der unterschiedlichen Qualität der chirurgischen Resektion in diesen Studien begrenzt und die Ansprechrate auf die präoperative Behandlung limitiert. Darüber hinaus ist die Zuverlässigkeit des klinischen Restagings nach präoperativer Behandlung ebenfalls eingeschränkt. Auf der anderen Seite gibt es aktuelle Evidenz, die partielle Gastrektomien durch Neubewertung der notwendigen Resektionsabstände mithilfe intraoperativer Schnellschnittmethoden sowie neuartiger Rekonstruktionen auch beim fortgeschrittenen Magenkarzinom unterstützt.

Schlussfolgerung

Die aktuelle Evidenz unterstützt nicht die Umsetzung einer vollständigen Magenerhaltung mit aktiver Nachsorge des Magenkarzinoms. Allerdings könnten zukünftig auch beim lokal fortgeschrittenen Magenkarzinom zunehmend partiell magenerhaltende Operationstechniken zur Anwendung kommen.

Abstract

Background

Perioperative or neoadjuvant therapy is the mainstay of treatment for locally advanced gastric cancer in Europe; however, data regarding possible modifications in the surgical strategy depending on the response to preoperative treatment are lacking.

Methods

This review was carried out based on a search of the relevant contemporary literature regarding neoadjuvant or perioperative treatment for gastric adenocarcinoma and the implications of tumor response for the subsequent surgical treatment.

Results

The most recent randomized trials showed a survival benefit after perioperative or neoadjuvant treatment for gastric cancer. Due to the variable response to the preoperatively administered part of the therapy, including complete response, it appears reasonable to develop an individualized surgical approach; however, scientific results supporting this approach are limited due to the variable quality of the surgical resection provided in these studies and the limited rate of complete response to preoperative treatment. Moreover, the reliability of clinical restaging after preoperative treatment is also limited. On the other hand, there is currently evidence that supports a re-evaluation of the necessary resection margins for partial gastrectomy in advanced gastric cancer with the help of intraoperative frozen sections and new reconstruction methods.

Conclusion

The current evidence does not support the implementation of a complete organ-sparing strategy with active follow-up surveillance for gastric cancer.; however, stomach-preserving partial gastrectomy techniques could be applied for advanced disease more often in the future.

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Correspondence to Peter Philipp Grimminger.

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Interessenkonflikt

G. Capovilla, C. Froiio, H. Lang, F. Berlth und P.P. Grimminger 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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Capovilla, G., Froiio, C., Lang, H. et al. Komplette Response nach neoadjuvanter Therapie beim Magenkarzinom: Implikationen für die Chirurgie. Chirurg (2021). https://doi.org/10.1007/s00104-021-01516-4

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Schlüsselwörter

  • Adenokarzinom
  • Magenerhaltung
  • Perioperative Behandlung
  • Gastrektomie
  • Lymphadenektomie

Keywords

  • Adenocarcinoma
  • Stomach preservation
  • Perioperative treatment
  • Gastrectomy
  • Lymphadenectomy