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Therapeutisches Vorgehen beim oligometastasierten Magen- und Ösophaguskarzinom

Therapeutic approach in oligometastatic gastric and esophageal cancer

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Zusammenfassung

Die Therapie von Patienten mit oligometastasierten Magen- und Ösophaguskarzinomen befindet sich in den letzten Jahren im Wandel. Bisher wird in den aktuellen S3-Leitlinien zum Magen- und Ösophaguskarzinom eine chirurgische Therapie nicht empfohlen. Allerding befassen sich heutzutage die bestehenden lokalen Tumorboards immer häufiger mit diesen Patienten. Durch die multimodalen Therapiekonzepte werden bei Patienten, die gut auf die Therapie ansprechen, vermehrt individuelle Indikationen gestellt und zusätzlich eine radikale Operation des Primärtumors und der Metastasen durchgeführt. In dieser Übersichtsarbeit werden die aktuellen Daten der vorliegenden Literatur besprochen und eine Grundlage für erweiterte chirurgische Therapien dargelegt. Zusätzlich mit den aktuell vorliegenden Daten der FLOT3-Studie und den meist retrospektiven Daten scheinen sich Patienten identifizieren zu lassen, die von einer aggressiven Therapie profitieren. Randomisierte prospektive Studien wie die RENAISSANCE/FLOT5-Studie und die GASTRIPEC-Studie müssen in der Zukunft weiter klären, ob eine aggressive chirurgische Therapie im multimodalen Therapiekonzept von metastasierten Magen- und Ösophaguskarzinomen eine weitere anerkannte Säule bilden wird.

Abstract

The therapeutic approach to patients with oligometastatic gastric cancer and esophageal cancer is currently undergoing a shift towards a more aggressive therapy including surgical resection. In the current German S3 guidelines surgical treatment of metastatic disease is not recommended; however, nowadays interdisciplinary tumor boards have to evaluate such patients increasingly more often. On an individual basis a radical surgical resection of the primary tumor and the metastases is considered and performed in patients who respond well to multimodal chemotherapy concepts. In this review article the currently available data from the literature are discussed and a foundation for individually extended surgical approaches is presented. Together with the currently available results of the FLOT 3 study and the mostly retrospective studies, it seems to be possible to identify patients who would profit from such an aggressive treatment. In the future randomized prospective studies, such as the RENAISSANCE/FLOT 5 study and the GASTRIPEC study will have to evaluate whether an aggressive surgical therapy within multimodal therapy concepts of metastatic gastric and esophageal carcinomas is warranted.

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  1. Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland

    T. Schmidt

  2. Department of Surgery, Upper-GI-Surgery, Geneva University Hospitals, Geneva, Schweiz

    S. P. Mönig

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Schmidt, T., Mönig, S.P. Therapeutisches Vorgehen beim oligometastasierten Magen- und Ösophaguskarzinom. Chirurg 88, 1024–1032 (2017). https://doi.org/10.1007/s00104-017-0548-3

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