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Differenziertes chirurgisches Vorgehen bei Adenokarzinomen des ösophagogastralen Übergangs

Differentiated surgical approach for adenocarcinoma of the gastroesophageal junction

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Zusammenfassung

Für Adenokarzinome des ösophagogastralen Übergangs (AEG) hat sich die Klassifikation nach Siewert mit seinen drei Subtypen als pragmatischer Ansatz für die chirurgische Therapie durchgesetzt. Bei Adenokarzinomen des distalen Ösophagus (AEG Typ I) ist die transthorakale Ösophagektomie mit Magenhochzug chirurgischer Standard. Die gastrale Rekonstruktion mit intrathorakaler Ösophagogastrostomie ist die häufigste Anastomosenform (Ivor-Lewis-Ösophagektomie). Sowohl der abdominelle wie thorakale Teil der Operation können über einen minimalinvasiven Zugang durchgeführt werden. Das subkardiale Magenkarzinom (AEG Typ III) kann sicher mit der transhiatal erweiterten Gastrektomie reseziert werden. Beim eigentlichen Kardiakarzinom (AEG Typ II) ist gegenwärtig nicht geklärt, mit welchem der beiden genannten Resektionsverfahren das bessere onkologische Langzeitüberleben erzielt werden kann. Wenn technisch möglich, ist bei besserer Lebensqualität die transhiatal erweiterte Gastrektomie zu bevorzugen. Bei AEG-Tumoren vom Typ II kann ein minimalinvasives Vorgehen nicht empfohlen werden, wenn präoperativ das Resektionsausmaß nicht sicher festgelegt werden kann.

Abstract

For adenocarcinoma of the gastroesophageal junction (GEJ) the classification of Siewert with its three subtypes is well established as a practical approach to surgical treatment. Transthoracic esophagectomy with gastric tube formation is generally accepted as the surgical standard for adenocarcinoma of the distal esophagus (GEJ type I). Intrathoracic esophagogastrostomy has become the most frequently used anastomotic technique (Ivor Lewis esophagectomy). Both the abdominal and thoracic part can be safely performed with a minimally invasive access. For subcardiac gastric cancer (GEJ type III) transhiatal extended gastrectomy is the resection of choice. For true cardiac carcinomas (GEJ type II) it has not yet been decided which of the abovementioned surgical procedures offers the best long-term survival. If technically possible in terms of a complete resection, transhiatal extended gastrectomy should be preferred because of a better postoperative quality of life. For GEJ type II tumors a minimally invasive approach is not recommended if the extent of resection cannot be safely determined preoperatively.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 90933, Köln, Deutschland

    W. Schröder, R. Lambertz & C. Bruns

  2. Department of Surgery, University Medical Center Utrecht, Utrecht, Niederlande

    R. van Hillegesberger

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  4. C. Bruns
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Correspondence to W. Schröder.

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W. Schröder, R. Lambertz, R. van Hillegesberger und C. Bruns geben an, dass kein Interessenkonflikt besteht.

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

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Schröder, W., Lambertz, R., van Hillegesberger, R. et al. Differenziertes chirurgisches Vorgehen bei Adenokarzinomen des ösophagogastralen Übergangs. Chirurg 88, 1010–1016 (2017). https://doi.org/10.1007/s00104-017-0544-7

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