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Diagnostik und Therapie des Magenkarzinoms

Diagnosis and treatment of gastric cancer

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Zusammenfassung

Das Magenkarzinom ist ein aggressiver Tumor, der aufgrund spät auftretender Symptomatik insgesamt mit einer schlechten Prognose einhergeht. Während das Magenfrühkarzinom durch endoskopische Abtragung behandelt werden kann, zeigten zahlreiche Studien, dass beim lokal fortgeschrittenen Magenkarzinom eine perioperative Chemotherapie die Prognose deutlich verbessert. Die chirurgische Therapie umfasst die subtotale bzw. totale Magenresektion mit Lymphadenektomie der Kompartimente 1 und 2 (D2). Eine zusätzliche Splenektomie oder Pankreasschwanzresektion erhöht die Morbidität und sollte vermieden werden. Bei fehlender Resektabilität kann eine palliative Chemotherapie (in Kombination mit Trastuzumab bei positivem HER2-Status) die Prognose verbessern. Zur Verbesserung der Lebensqualität sind endoskopische oder ggf. operative Verfahren geeignet. Die Nachsorge nach onkologischer Behandlung erfolgt symptomorientiert, eine regelmäßige Vitamin-B12-Substitution ist essenziell.

Abstract

Gastric cancer is a very aggressive tumor. Due to the late onset of symptoms most tumors are diagnosed in an advanced stage. For early gastric cancer endoscopic resection is a well-established treatment. In case of locally advanced tumor stage several studies have shown a significant survival benefit for perioperative chemotherapy. Surgical treatment includes subtotal or total gastric resection with radical lymphadenectomy of lymph node groups of both compartments 1 and 2. An additional splenectomy or distal pancreatic resection should be avoided to reduce postoperative morbidity. In case of non-resectable tumor palliative chemotherapy can improve the prognosis (combined with trastuzumab in case of a positive HER2 status). For improvement of quality of life endoscopic or surgical procedures can be offered. Follow-up is only clinically oriented with the need for regular vitamin B12 substitution.

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Einhaltung ethischer Richtlinien

Interessenskonflikt. G. Woeste gibt an. dass kein Interessenskonflikt besteht. S.E. Al-Batran und J. Trojan üben Beratertätigkeit für Lilly Deutschland GmbH und Roche Deutschland Holding GmbH aus. J. Albert erhält Studiensupport von Olympus GmbH und Given Imaging Ltd.

Dieser Beitrag beinhaltete keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    G. Woeste

  2. Institut für Klinisch-Onkologische Forschung, Krankenhaus Nordwest, Frankfurt am Main, Deutschland

    S.E. Al-Batran

  3. Medizinische Klinik I, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland

    J. Albert & J. Trojan

Authors
  1. G. Woeste
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  2. S.E. Al-Batran
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  3. J. Albert
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  4. J. Trojan
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Correspondence to G. Woeste.

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Woeste, G., Al-Batran, S., Albert, J. et al. Diagnostik und Therapie des Magenkarzinoms. Onkologe 20, 1139–1152 (2014). https://doi.org/10.1007/s00761-014-2792-1

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  • DOI: https://doi.org/10.1007/s00761-014-2792-1

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