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Chirurgische Therapiestrategien beim Ösophagus- und Magenkarzinom

Surgical strategies for esophageal and gastric cancer

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Zusammenfassung

Diese Übersichtsarbeit hat zum Ziel, die aktuellen chirurgischen Strategien bei der Behandlung des Ösophagus- und Magenkarzinoms zusammenzufassen. Neben den etablierten Standardverfahren wird auf die limitierten Resektionen bei Frühkarzinomen und den Stellenwert der Chirurgie im multimodalen Behandlungskonzept bei lokal fortgeschrittenen T3/4-Tumoren eingegangen. Das Plattenepithelkarzinom und das Adenokarzinom (Barrett-Karzinom) der Speiseröhre werden aufgrund der unterschiedlichen Pathogenese und Tumorbiologie sowie differenzierter unterschiedlicher Vorgehensweisen separat dargestellt. Aufgrund der überwiegend distalen Lokalisation der Barrett-Karzinome ist eine Abgrenzung zu den echten Kardiakarzinomen und Tumoren, die im Magen ihren Ursprung nehmen und die distale Speiseröhre infiltrieren, erforderlich. Basierend auf der Klassifikation nach Siewert wird das Barrett-Karzinom deshalb zusammen mit den so genannten Adenokarzinomen des ösophagogastralen Übergangs (AEG) behandelt. Für die Weiterentwicklung der chirurgischen Therapiestrategien beim Magenkarzinom haben sich die asiatischen, insbesondere japanischen und südkoreanischen Kollegen große Verdienste erworben. Moderne, dort entwickelte, aber noch nicht in der westlichen Welt etablierte Strategien werden neben den Standardverfahren gebührend berücksichtigt. Für alle diese Tumoren gilt, dass die chirurgische Therapie ein elementarer Bestandteil im Rahmen eines kurativen Behandlungskonzepts ist. Sie ist aber differenzierter und Teil eines komplexen interdisziplinären Algorithmus; deshalb ist eine weitere Spezialisierung zum Wohle der Patienten ratsam.

Abstract

This review summarizes surgical strategies for esophageal and gastric cancers. In addition to well-established standardized procedures, more recently developed limited resections for early cancers and multimodality treatments for locally advanced T3/4 tumors are discussed. Esophageal squamous cell cancer and adenocarcinoma (Barrett’s cancer) are discussed individually because of their different pathogenesis, tumor biology, and applied treatment strategies. Because Barrett’s cancer is usually located in the distal esophagus, it should be distinguished from true cancer of the gastric cardia and gastric cancers invading the distal esophagus. Based on the classification of Siewert, esophageal adenocarcinoma is therefore discussed in context with adenocarcinomas of the esophagogastric junction. For the recent developments in surgical strategies for gastric cancer, our Asian, especially Japanese and South Korean, colleagues deserve particular merit. Modern techniques developed in those countries and not yet established in the West are extensively discussed along with our common standard procedures. It is still true for all these different tumors that surgical resection is an elementary part of curative treatment strategies; however, treatment is becoming more and more differentiated and interdisciplinary and therefore requires further specialization for our patients’ sake.

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  1. Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Raemistr. 100, 8008, Zürich, Schweiz

    P.M. Schneider, M.K. Müller & M. Schiesser

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  1. P.M. Schneider
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  2. M.K. Müller
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Correspondence to P.M. Schneider.

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Schneider, P., Müller, M. & Schiesser, M. Chirurgische Therapiestrategien beim Ösophagus- und Magenkarzinom. Gastroenterologe 4, 209–223 (2009). https://doi.org/10.1007/s11377-008-0271-1

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