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Grenzen der Chirurgie bei Karzinomen des oberen Intestinaltraktes

Limitations of surgery for cancer of the upper gastrointestinal tract

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Zusammenfassung

Karzinome des oberen Intestinaltraktes gehören weltweit zu den häufigsten tumorbedingten Todesursachen. Während die Inzidenz der Ösophaguskarzinome kontinuierlich ansteigt, sinkt die Zahl der Neuerkrankungen beim Magenkarzinom in den letzten Jahrzehnten stetig. Die Diagnose wird häufig in einem fortgeschrittenen Tumorstadium gestellt, die Gesamtprognose ist schlecht.

Die chirurgische Resektion ist nach wie vor für viele Patienten zentraler Bestandteil der onkologischen Therapie. Allerdings haben Fortschritte in Diagnostik und Therapie ösophagogastraler Karzinome zu einer immer größeren Individualisierung der Therapie geführt. Bei den frühen Karzinomen haben die endoskopischen Resektionen inzwischen einen festen Stellenwert mit hoher Heilungsrate. Bei fortgeschrittenen Tumoren konnte in den letzten Jahren eine deutliche Verbesserung der Prognose durch Implementierung multimodaler Therapiekonzepte, durch die Standardisierung der Operationstechniken sowie des perioperativen Managements erreicht werden. Die Grenzen der Chirurgie werden somit durch aktuelle wissenschaftliche Ergebnisse, chirurgisch-technische Entwicklungen sowie patientenspezifische Faktoren bestimmt. Sie verschieben sich fortwährend und bedürfen deswegen einer ständigen Überprüfung.

Abstract

Cancer of the upper gastrointestinal tract is one of the leading causes for cancer related deaths worldwide. While the incidence of esophageal carcinoma is increasing, the incidence of gastric cancer has been continuously decreasing over the past decades. Most patients are often diagnosed with advanced stage disease and the prognosis is still dismal. For many patients surgery is the central part of the therapy; however, improvements in the diagnostic work-up, staging techniques and therapy concepts have led to a more individualized therapeutic approach. Endoscopic treatment of early cancer is well established with high cure rates. In advanced gastric cancer the implementation of multimodal therapies, standardized surgical techniques and optimized perioperative management has led to an improvement in prognosis and outcome. The limitations of surgery in esophagogastric cancer are defined by current scientific results, recent technical developments and patient-specific characteristics. These limitations are continuously changing and require an ongoing review.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. E. Karakas, C. Oetzmann von Sochaczewski, T. Haist, M. Pauthner und D. Lorenz geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Dr. Horst-Schmidt Klinik, Ludwig-Erhard Str. 100, 65199, Wiesbaden, Deutschland

    E. Karakas, C. Oetzmann von Sochaczewski, T. Haist, M. Pauthner &  D. Lorenz

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  1. E. Karakas
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  2. C. Oetzmann von Sochaczewski
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  3. T. Haist
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Correspondence to D. Lorenz.

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Karakas, E., Oetzmann von Sochaczewski, C., Haist, T. et al. Grenzen der Chirurgie bei Karzinomen des oberen Intestinaltraktes. Chirurg 85, 186–191 (2014). https://doi.org/10.1007/s00104-013-2598-5

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