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Die neue S3-Leitlinie zum Ösophaguskarzinom

Wichtige chirurgische Aspekte

New S3 guideline for esophageal cancer

Important surgical aspects

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Zusammenfassung

Die aktuelle S3-Leitlinie stellt die Empfehlungen zur Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus basierend auf Literaturevidenz und interdisziplinärem Expertenkonsens dar. Die Ösophagogastroskopie mit Biopsie, die Endosonographie und die Computertomographie von Hals, Thorax und Abdomen sind entscheidend für das Staging und die Wahl der Behandlung. Bei kurativem Ansatz ist die Chirurgie insbesondere in Form der transthorakalen Ösophagektomie mit Magenhochzug die entscheidende Behandlungsoption außer bei auf Mukosa beschränkten Tumoren oder zervikalen Plattenepithelkarzinomen. Der Stellenwert der total minimalinvasiven Ösophagusresektion oder der Hybridtechnik ist noch unsicher. In der Kategorie cT3- oder bei resektablem cT4-Tumor soll bei Plattenepithelkarzinomen und Adenokarzinomen eine neoadjuvante Radiochemotherapie, bei Adenokarzinomen alternativ eine perioperative Chemotherapie durchgeführt werden. Palliative Resektionen sollen unterbleiben und durch interventionelle Verfahren zur Palliation ersetzt werden.

Abstract

The current German S3 guideline represents the recommendations for the diagnosis and therapy of squamous cell carcinomas and adenocarcinomas of the esophagus based on evidence from the literature and interdisciplinary expert consensus. Esophagogastroscopy with biopsy, endosonography, and spiral CT scan of the neck, thorax, and abdomen are decisive in staging and the choice of therapy. For a curative approach, surgery, especially transthoracic esophagectomy and gastric pull-up, is the most important therapeutic option, except in the case of mucosal carcinomas or cervical squamous cell carcinomas. The significance of total minimally invasive esophageal resection or a hybrid technique is still uncertain. In category cT3 or resectable cT4 tumors, neoadjuvant radiochemotherapy should be performed in squamous cell carcinomas or adenocarcinomas. Alternatively, perioperative chemotherapy can be carried out in adenocarcinoma. Palliative resections should be avoided and replaced by interventional procedures for palliation.

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Authors and Affiliations

  1. Zentrum f. Speiseröhren- und Magenchirurgie, Agaplesion Markuskrankenhaus, Wilhelm-Epstein-Str. 4, 60431, Frankfurt/Main, Deutschland

    A. H. Hölscher

  2. Klinik für Internistische Onkologie und Hämatologie, Kliniken Essen Mitte, Essen, Deutschland

    M. Stahl

  3. III. Medizinische Klinik, Klinikum Augsburg, Augsburg, Deutschland

    H. Messmann

  4. Klinik für Strahlentherapie, Universität Essen, Essen, Deutschland

    M. Stuschke

  5. Deutsche Gesellschaft für Chirurgie, Berlin, Deutschland

    H. J. Meyer

  6. Klinik für Innere Medizin, Klinikum Bremen Ost, Bremen, Deutschland

    R. Porschen

Authors
  1. A. H. Hölscher
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  2. M. Stahl
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  3. H. Messmann
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  4. M. Stuschke
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  5. H. J. Meyer
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  6. R. Porschen
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Corresponding author

Correspondence to A. H. Hölscher.

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Interessenkonflikt

A.H. Hölscher, M. Stahl, H. Messmann, M. Stuschke, H. J. Meyer und R. Porschen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hölscher, A.H., Stahl, M., Messmann, H. et al. Die neue S3-Leitlinie zum Ösophaguskarzinom. Chirurg 87, 865–872 (2016). https://doi.org/10.1007/s00104-016-0214-1

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  • DOI: https://doi.org/10.1007/s00104-016-0214-1

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