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Spektrum der laparoskopischen Chirurgie bei Magentumoren

Spectrum of laparoscopic surgery for gastric tumors

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Zusammenfassung

Minimalinvasive Operationsverfahren kommen zunehmend bei Tumoren des oberen Gastrointestinaltrakts zum Einsatz. Während sich die minimalinvasive Chirurgie (MIC) bei gutartigen Tumoren und gastrointestinalen Stromatumoren (GIST) nach aktueller Studienlage als Standardverfahren etabliert hat, wird deren Bedeutung für das Magenkarzinom kontrovers diskutiert. Für das Magenkarzinom liegen bislang überwiegend Studien und Metaanalysen aus Asien vor, die Vorteile für die MIC hinsichtlich des intraoperativen Blutverlusts, der chirurgischen Minorkomplikationen und einer rascheren Rekonvaleszenz ohne Benefit bei den onkologischen Langzeitergebnissen und der Lebensqualität aufzeigen. Im Gegensatz zur Situation in Deutschland werden Magenkarzinome in Asien bei hoher Inzidenz mit 50 %igem Anteil von Frühkarzinomen und zumeist distaler Tumorlokalisation in „High-volume“-Zentren behandelt. Aufgrund der in den publizierten Studien nachgewiesenen marginalen Vorteile der MIC gegenüber der offenen Resektion kann aktuell keine generelle Empfehlung für die laparoskopische Chirurgie des Magenkarzinoms gegeben werden.

Abstract

Minimally invasive operative procedures are increasingly being used for treating tumors of the upper gastrointestinal tract. While minimally invasive surgery (MIS) has become established as a standard procedure for benign tumors and gastrointestinal stromal tumors (GIST) based on current studies, the significance of MIS in the field of gastric cancer is the topic of heated debate. Until now the majority of studies and meta-analyses on gastric cancer have come from Asia and these indicate the advantages of MIS in terms of intraoperative blood loss, minor surgical complications and swifter convalescence although without any benefits in terms of long-term oncological results and quality of life. Unlike in Germany, gastric cancer in Asia with its unchanged high incidence rate, 50 % frequency of early carcinoma and predominantly distal tumor localization is treated at high-volume centres. Due to the proven marginal advantages of MIS over open resection described in the published studies no general recommendation for laparoscopic surgery of gastric cancer can currently be given.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S.P. Mönig, S.H. Chon, J. Weindelmayer, G. de Manzoni, A.H. Hölscher geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    S.P. Mönig, S.H. Chon, J. Weindelmayer & A.H. Hölscher

  2. Upper G.I. Division Department of Surgery , Universität Verona, Verona, Italien

    J. Weindelmayer & G. de Manzoni

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  1. S.P. Mönig
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  2. S.H. Chon
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  3. J. Weindelmayer
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  4. G. de Manzoni
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  5. A.H. Hölscher
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Mönig, S., Chon, S., Weindelmayer, J. et al. Spektrum der laparoskopischen Chirurgie bei Magentumoren. Chirurg 85, 675–682 (2014). https://doi.org/10.1007/s00104-014-2753-7

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