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Chirurgische und interdisziplinäre Therapie gastrointestinaler Stromatumoren

Surgical and interdisciplinary treatment of gastrointestinal stromal tumors

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Zusammenfassung

Gastrointestinale Stromatumoren (GISTs) sind die häufigsten potenziell malignen mesenchymalen Tumoren des Gastrointestinaltraktes. Seit der Einführung von Imatinib und weiterer Tyrosinkinaseinhibitoren wurde die Therapie von GISTs durch die Inhibition der Tyrosinkinasen c‑Kit und PDGFRα revolutioniert. Trotz der zielgerichteten Therapie ist eine Heilung weiterhin nur durch eine Operation mit Resektion des Primärtumors zu erreichen. Durch eine multimodale interdisziplinäre Therapie kann heute auch in der metastasierten Situation mit kompletter Resektion des Primärtumors und der Metastasen die Prognose erheblich verbessert oder sogar eine Heilung erzielt werden. Eine neoadjuvante Therapie kann das Resektionsausmaß vermindern und hierdurch den Organ(teil)erhalt und eine Verringerung der chirurgischen Morbidität ermöglichen. Um die molekularen und klinischen Prädiktoren regelrecht zu gewichten und die optimale Therapie zu gewährleisten, sollten Patienten mit GISTs, sicher aber Patienten mit fortgeschrittenen GISTs, in interdisziplinären Sarkomboards vorgestellt und beraten werden.

Abstract

Gastrointestinal stromal tumors (GISTs) are the most frequent potentially malignant mesenchymal tumors of the gastrointestinal tract. The treatment of GISTs has been revolutionized since imatinib and other tyrosine kinase inhibitors were introduced for the treatment of GISTs, which inhibit the tyrosine kinases c‑KIT and platelet-derived growth factor receptor (PDGFR) alpha. Even after the introduction of this targeted treatment GISTs can only be cured by surgical resection. With interdisciplinary multimodal treatment the prognosis of metastasized GIST can now be further improved by surgical resection of the primary tumor and the metastases, potentially leading to a cure. Neoadjuvant therapy can reduce the extent of surgical resection and hereby enable organ preservation and reduce surgical morbidity. To evaluate molecular and clinical predictors and to offer an optimal therapeutic plan, patients with GISTs and certainly patients with advanced GISTs should be evaluated by interdisciplinary sarcoma boards.

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  1. Klinik für Allgemein‑, Viszeral‑, Tumor und Transplantationschirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Thomas Schmidt, Markus Ghadimi, Hans F. Fuchs & Christiane J. Bruns

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  1. Thomas Schmidt
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Correspondence to Thomas Schmidt.

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T. Schmidt, M. Ghadimi, H.F. Fuchs und C.J. Bruns 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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M. Schneider, Heidelberg

M. W. Büchler, Heidelberg

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Schmidt, T., Ghadimi, M., Fuchs, H.F. et al. Chirurgische und interdisziplinäre Therapie gastrointestinaler Stromatumoren. Chirurg 93, 27–33 (2022). https://doi.org/10.1007/s00104-021-01527-1

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