Möglichkeiten und Grenzen der minimalinvasiven Chirurgie bei Resektion des Ösophagus und des Magens

 

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Zusammenfassung

Hintergrund: Minimalinvasive Operationsverfahren erfahren bei der Behandlung von Karzinomen des oberen Gastrointestinaltrakts eine zunehmende Verbreitung, wobei mögliche Vorteile und die onkologische Radikalität weiterhin kontrovers diskutiert werden.
Methode: Im Rahmen einer Literaturübersicht werden die aktuellen Studien zur minimalinvasiven Ösophagusresektion und zur laparoskopischen Magenresektion analysiert.
Ergebnisse: Minimalinvasive Ösophagusresektionen und laparoskopische Magenresektionen beim Karzinom sind sicher und führen zu Vorteilen hinsichtlich eines geringeren Blutverlusts, geringerer Schmerzen, einer kürzeren Krankenhausverweildauer und einer Reduktion der perioperativen Morbidität. Pulmonale Komplikationen nach Ösophagusresektion werden durch den Einsatz minimalinvasiver Operationsverfahren reduziert. Die Operationszeit ist bei minimalinvasiven Operationen länger als bei offenen Eingriffen. Die Letalität unterscheidet sich nicht. Das onkologische Resektionsausmaß ist vergleichbar. Wenige Studien zeigten für die laparoskopische Magenresektion eine gering reduzierte Anzahl an Lymphknoten, das Langzeitüberleben unterscheidet sich nicht von der konventionellen Operation.
Schlussfolgerung: Minimalinvasive Ösophagus- und Magenresektionen sind sicher, zeigen zahlreiche Vorteile in der postoperativen Rekonvaleszenz und führen zu einer reduzierten Morbidität. Bei ihrer Anwendung müssen die onkologischen Standards der konventionellen Operation eingehalten werden.

Abstract

Background: Although minimally invasive surgery is being increasingly performed for the treatment of upper gastrointestinal cancers, the discussion on potential advantages and oncological accuracy is still controversial.
Material and Methods: In the framework of a literature survey, current trials on minimally invasive oesophageal resection and laparoscopic abdominal surgery have been analysed.
Results: Minimally invasive oesophagectomy and laparoscopic gastric resections for cancer are safe. Minimally invasive resections result in an improved short-term outcome postoperatively in view of less pain, less blood loss and shorter duration of hospital stay. While mortality is equal, morbidity following minimally invasive surgery is reduced. Especially pulmonary complications decrease on the application of minimally invasive oesophagectomy. Minimally invasive operations last longer than open procedures. The oncological results seem to be equal between open and minimally invasive operations. A few studies have shown that laparoscopic gastric resections may result in a reduced number of lymph nodes harvested. The long-term survival between open and laparoscopic resections did not differ in any study.
Conclusion: Minimally invasive resections for oesophageal and gastric cancer are safe and show several advantages in short-term outcome. Oncological long-term results seem to be comparable. The potential risk of a reduced number of harvested lymph nodes during laparoscopic gastrectomy has to be addressed by an adequate surgical technique.

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