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Ösophaguskarzinom

  • J. R. Siewert
  • H. J. Stein
  • A. Sendler
  • U. Fink

Zusammenfassung

Aus epidemiologischer und tumorbiologischer Sicht muss zwischen Plattenepithel- und Adenokarzinomen der Speiseröhre unterschieden werden. Die grundsätzlichen chirurgischen Therapieprinzipien sind allerdings für beide Tumoren gleich. Nach wie vor gilt die RO-Resektion als wesentliches chirurgisches Therapieziel. Dieses kann bei T1 und T2 Tumoren sicher erreicht werden. Bei lokal fortgeschrittenen Tumoren (T3 und T4) werden derzeitig neoadjuvante Therapieprinzipien erprobt. Von dieser Therapie profitieren Patienten, die auf die Vorbehandlung mit einer Tumorreduktion („Downsizing“ oder gar „Downstaging“) ansprechen. Sogenannte „Non-Responder“ haben eine schlechte Prognose. Ihnen steht nur eine palliative Therapie zur Verfügung.

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Literatur

  1. Aikou T, Shimazu H (1989) Difference in main lymphatic pathways from the lower esophagus and gastric cardia. Jpn J Surg 19: 290–295PubMedCrossRefGoogle Scholar
  2. Akiyama H (1980) Surgery for carcinoma of the esophagus. Curr Probl Surg 27: 53–120CrossRefGoogle Scholar
  3. Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220: 364–372PubMedCrossRefGoogle Scholar
  4. Baba M, Aikou T, Yoshinak, H, Natsugo, S, Fukumoto T, Shimazu H, Akazawa K (1964) Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg 219: 310–316CrossRefGoogle Scholar
  5. Bartels H, Stein HJ, Schömig A, Siewert JR (1997) Chirurgie bei Risikopatienten unter Notfall-and Elektivbedingungen: Risikoerfassung. Chirurg 68: 654–661Google Scholar
  6. Bartels H, Stein HJ, Siewert JR (1998 a) Frühextubation versus Spätextubation nach Resektion beim Ösophaguscarcinom. Langenbecks Arch Chir 115 Supp12: 1074–1076Google Scholar
  7. Bartels H, Stein HJ, Siewert JR (1998 b) Preoperative risk-analysis and postoperative mortality of osophagectomy for resectable oesophageal cancer. Br J Surg 85: 840–844Google Scholar
  8. Bartels H, Stein HJ, Siewert JR ( 1998 c) Tracheobronchial lesions following oesophagectomy: Predisposing factors, respiratory management and outcome. Br J Surg 85: 403–406Google Scholar
  9. Blom D, Peters JH (2000) Surgery, radiotherapy, and chemotherapy in carcinoma of the esophagus. Curr Opin Gastroenterol 16: 392–399PubMedCrossRefGoogle Scholar
  10. Bollschweiler E, Hölscher AH (2000) Deutliche Zunahme des Adenokarzinoms im Ösophagus. Dtsch Aerztebl 97: A1896–A1900Google Scholar
  11. Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous cell cancer of the esophagus. N Engl J Med 337: 161–167PubMedCrossRefGoogle Scholar
  12. Casson AG, Rusch VW, Ginsberg RJ, Zankowicz N, Finley RF (1994) Lymph node mapping of esophageal cancer. Ann Thorac Surg 58: 1560–1561CrossRefGoogle Scholar
  13. Chow WH, Blaser MJ, Blot WJ et al. (1998) An inverse relation between cagA+ strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res 58: 588–590PubMedGoogle Scholar
  14. Daly JD, Fry WA, Little AG, Winchester DP, McKee RF, Stewart AK, Fremgen A M (2000) Esophageal cancer: Results of an American College of Surgeons Patient Care Evaluation Study. J Am Coll Surg 190: 562–573Google Scholar
  15. Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83: 2049–2053PubMedCrossRefGoogle Scholar
  16. Dittler HJ, Siewert JR (1993) Role of endoscopic ultrasonography in esophageal cancer. Endoscopy 25: 156–161PubMedCrossRefGoogle Scholar
  17. Ell C, May A, Gossner L et al. (2000) Endoscopic mucosal resection of early cancer and high grade dysplasia in Barrett’s esophagus. Gastroenterology 118: 670–677PubMedCrossRefGoogle Scholar
  18. Feith M, Werner M, Rosenberg R, Roder JD, Stein HJ (2000) Lymph node ‘micrometastases’ and ‘microinvolvement’ in esophageal carcinoma. Onkologie 13: 330–333CrossRefGoogle Scholar
  19. Fink U, Stein HJ, Bochtler H, Wilke HJ, Siewert JR (1994) Neo-adjuvant therapy for squamous cell esophageal carcinoma. Ann Oncol 5: S17–S26CrossRefGoogle Scholar
  20. Fink U, Stein HJ, Wilke HJ, Roder JD, Siewert JR (1995) Multimodal treatment for squamous cell esophageal cancer. World J Surg 19: 198–204PubMedCrossRefGoogle Scholar
  21. Fink U, Stein HJ, Siewert JR (1998) Multimodale Therapie bei Tumoren des oberen Gastrointestinaltrakts. Chirurg 69: 349–359PubMedCrossRefGoogle Scholar
  22. Fujita H, Kakegawa T, Yamana H, Shima I (1994) Lymph node compartments as guidelines of lymphadenectomy for esophageal carcinoma. Dis Esoph 7: 169–177Google Scholar
  23. Fujita H, Kakegawa T, Yamana H et al. (1995) Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Ann Surg 222: 654–662PubMedCrossRefGoogle Scholar
  24. Fumagalli U and Panel of Experts (1996) Resective surgery for cancer of the thoracic esophagus. Results of a consensus conference. Dis Esoph 9: 3–19Google Scholar
  25. Gammon MD, Schoenberg JB, Ahsan H et al. (1997) Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 89: 1277–1284PubMedCrossRefGoogle Scholar
  26. Hölscher AH, Bollschweiler E, Bumm R, Bartels H, Siewert JR (1995 a) Prognostic factors of resected adenocarcinoma of the esophagus. Surgery 118: 845–855Google Scholar
  27. Hölscher AH, Bollschweiler E, Schneider PM, Siewert JR (1995 b) Prognosis of early esophageal cancer. Cancer 76: 178–186Google Scholar
  28. Hölscher AH, Becker K, Höfler H, Fink U, Siewert JR (1996) Plattenepithel-Frühcarcinom des Ösophagus. Multizentrizität, Metastasierungsmuster und Prognose. Chirurg 67: 357–361Google Scholar
  29. Itzbicki JR, Hosch SB, Pichlmeier U et al. (1997) Prognostic value of immunohistochemically identifiable tumor cells in lymph nodes of patients with completely resected esophageal cancer. N Engl J Med 337: 1188–1194CrossRefGoogle Scholar
  30. Japanese Society for Esophageal Diseases (1976) Guidelines for the clinical and pathologic studies on carcinoma of the esophagus. Jpn J Surg 6: 69–78PubMedCrossRefGoogle Scholar
  31. Kelsen D (1997) Multimodal therapy for adenocarcinoma of the esophagus. Gastroenterol Clin North Am 26: 635–645PubMedCrossRefGoogle Scholar
  32. Kok TC, van Lanschot J, Siersema PD, van Overhagen H, Tilanus HW (1997) Neoadjuvant chemotherapy in operable squamous cell cancer: final report of a phase III multicenter randomized trial. Proc Am Soc Clin Oncol 17, A 984Google Scholar
  33. Lagergren J, Bergstrom R, Nyren 0 (1999 a) Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 130: 883–890Google Scholar
  34. Lagergren JL, Bergstrom R, Lindgren A, Nyren (1999 b) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340: 825–831Google Scholar
  35. Law S, Fok M, Chow S, Chu KM, Wong J (1997) Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 114: 210–217PubMedCrossRefGoogle Scholar
  36. Lehnert T (1999) Multimodal therapy for squamous carcinoma of the oesophagus. Br J Surg 86: 727–739PubMedCrossRefGoogle Scholar
  37. Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D (1994) A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer 73: 1779–1784PubMedCrossRefGoogle Scholar
  38. Liebermann-Meffert D (1995) Anatomy, embryology and histology. In: Pearson FG, Deslauriers J, Hibert CA, Ginsberg RJ, McKneally MF, Urschel HC (eds) Esophageal Surgery. Churchill Livingstone, New York, pp 1–26Google Scholar
  39. Miller JD, Jain MK, de Gara CJ, Morgan D, Urschel JD (1997) Effect of surgical experience on results of esophagectomy for esophageal carcinoma. J Surg Oncol 65: 20–21PubMedCrossRefGoogle Scholar
  40. Natsugoe S, Mueller J, Stein HJ, Feith M, Höfler H, Siewert JR (1998) Micrometastasis and tumor cell microinvolvement of lymph nodes esophageal squamous cell cancer: Frequency, associated tumor characteristics and impact on prognosis. Cancer 83: 858–866Google Scholar
  41. Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175: 47–51PubMedCrossRefGoogle Scholar
  42. Nishimaki T, Tanaka 0, Suzuki T, Aizawa K, Hatakeyama K, Muto T (1994) Patterns of lymphatic spread in thoracic esophageal carcinoma. Cancer 74: 4–11Google Scholar
  43. Nygaard K, Hagen S, Hansen HS, Hatlevoll R, Hultborn R, Jakobsen A (1992) Preoperative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 16: 1104–1109Google Scholar
  44. Riedel M, Hauck RW, Stein HJ, Mounyam L, Schulz C, Schömig A, Siewert JR (1998) Preoperative bronchoscopic assessment of airway invasion by esophageal cancer: A prospective study. Chest 113: 687–695Google Scholar
  45. Roder JD, Busch R, Stein HJ, Fink U, Siewert JR (1994) Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the esophagus. Br J Surg 81: 410–413PubMedCrossRefGoogle Scholar
  46. Roder JD, Stein HJ, Siewert JR (1995) Oesophageal cancer. In: Hermanek P, Gospododarowicz MK, Henson DE, Hutter RVP, Sobin LH (eds) Prognostic factors in cancer. Springer, Berlin Heidelberg New York Tokyo, pp 37–46CrossRefGoogle Scholar
  47. Roth JA, Pass HI, Flanagan MM, Graeber GM, Rosenberg JC, Steinberg S (1988) Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg 96: 242–248PubMedGoogle Scholar
  48. Ruol A and Panel of Experts (1996) Multimodality treatment for non-metastatic cancer of the thoracic esophagus. Results of a consensus conference. Dis Esoph 9: 39–54Google Scholar
  49. Schlag PM (1992) Randomized trial of preoperative chemotherapy for squamous cell cancer of the esophagus. Chirurgische Arbeitsgemeinschaft für Onkologie der Deutschen Gesellschaft für Chirurgie Study Group. Arch Surg 127: 14461450Google Scholar
  50. Siewert JR, Stein HJ (1997) Barrett’s cancer: Indications, extent and results of surgical resection. Sem Surg Oncol 13: 245252Google Scholar
  51. Siewert JR, Stein HJ (1998) Classification of carcinoma of theGoogle Scholar
  52. esophagogastric junction Br J Surg 85: 1457–1459Google Scholar
  53. Siewert JR, Stein HJ (1999) Lymphadenectomy for esophagealGoogle Scholar
  54. cancer. Langenbecks Arch Surg 384: 141–148Google Scholar
  55. Siewert JR, Bartels H, Bollschweiler E, Dittler HJ, Fink U, Hölscher AH, Roder JD (1992) Plattenepithelcarcinom des Ösophagus: Behandlungskonzepte der Chirurgischen Klinik der Technischen Universität München. Chirurg 63: 693–699Google Scholar
  56. Siewert JR, Hölscher AH, Bollschweiler E, Stein HJ, Fink U (1994) Chirurgie des Barrett Carcinoms. Chirurg 66: 10 2109Google Scholar
  57. Siewert JR, Stein HJ, Liebermann D, Bartels H (1995) The gastric tube as esophageal substitute. Dis Esoph 8: 11–19Google Scholar
  58. Siewert JR, Stein HJ, Sendler A (1997) Chirurgische Relevanz bildgebender Diagnostik bei Tumoren des Gastrointestinaltrakts–Entscheidungswege beim Ösophagus-, Magen, Colon-und Rektumcarcinom. Chirurg 68: 317–324Google Scholar
  59. Siewert JR, Feith M, Werner M, Stein HJ (2000) Adenocarcinoma of the esophagogastric junction. Results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg 232: 353–361CrossRefGoogle Scholar
  60. Spechler SJ, Goyal RK (1996) The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology 110: 614–621PubMedCrossRefGoogle Scholar
  61. Stein HJ, Siewert JR (1993) Endobrachyösophagus: Pathogenese, Epidemiologie und maligne Degeneration. Dtsch Med Wochenschr 118: 511–519Google Scholar
  62. Stein HJ, Siewert JR (1994) Klinische Bedeutung der Präkanzerosen des Ösophagus. In: Häring R (Hrsg) Krebsrisikoerkrankungen des Verdauungstrakts. Blackwell, Berlin, S 3140Google Scholar
  63. Stein HJ and Panel of Experts (1996) Esophageal cancer: Screening and surveillance. Results of a consensus conference. Dis Esoph 9 Suppl 1: 3–19Google Scholar
  64. Stein HJ, Kraemer SJM, Feussner H, Siewert JR (1997) Clinical value of diagnostic laparoscopy with laparoscopic ultrasound in patients with cancer of the esophagus or cardia. J Gastrointest Surg 1: 167–173PubMedCrossRefGoogle Scholar
  65. Stein HJ, Kauer WKH, Feussner H, Siewert JR (1998) Bile reflux in benign and malignant Barrett’s esophagus. Effect of medical acid suppression and fundoplication. J Gastrointest Surg 2: 333–341Google Scholar
  66. Stein HJ, Feith M, Feussner H (2000 a) The relationship between gastroesophageal reflux, development of Barrett’s epithelium and cancer of the esophagus. Langenbecks Arch Surg 385: 309–316Google Scholar
  67. Stein HJ, Feith M, Siewert JR ( 2000 b) Malignant degeneration of Barrett’s esophagus. Clinical point of view. Recent Results Cancer Res 155: 119–122Google Scholar
  68. Stein HJ, Feith M, Müller J, Werner M, Siewert JR (2000 c) Limited resection for early Barrett’s cancer. Ann Surg 232: 733–742Google Scholar
  69. Stein HJ, Sendler A, Fink U, Siewert JR (2000 d) Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am 80: 659–682Google Scholar
  70. Stein HJ, Brücher BLDM, Feith M, Werner M, Molls M, Fink U, Roder JD ( 2000 e) Ösophaguskarzinom. In: Roder JD, Stein HJ, Fink U (Hrsg) Therapie gastrointestinaler Tumoren. Prinzipien der chirurgischen Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München. Springer, Berlin Heidelberg New York Tokyo, S 187–207Google Scholar
  71. UICC/International Union against Cancer (1997) TNM classification of malignant tumors. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  72. Urba S, Orringer M, Turrisi A, Whyte R, Iannettoni M, Forastiere A (1997) A randomized trial comparing surgery to preoperative concomitant chemoradiation plus surgery in patients with resectable esophageal cancer: updated analysis. Proc Am Soc Clin Oncol 16, A 983Google Scholar
  73. Walsh TN, Noonan N, Hollywood D et al. (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335: 462–467PubMedCrossRefGoogle Scholar
  74. Werner M, Mueller J, Walch A, Höfler H (1999) The molecular pathology of Barrett’s esophagus. Histol Histopathol 14: 553–559PubMedGoogle Scholar
  75. Wilke HJ, Fink U (1996) Multimodal therapy for adenocarcinoma of the esophagus and esophagogastric junction. N Engl J Med 335: 509–510PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • J. R. Siewert
  • H. J. Stein
  • A. Sendler
  • U. Fink

There are no affiliations available

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