Kurative endoskopische Therapie: Welche Läsionen eignen sich?

 

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Zusammenfassung

Durch die Einführung der flächendeckenden Vorsorgekoloskopie ist die Kolonkarzinominzidenz gesunken und die Diagnosestellung dieser Tumoren in frühen, endoskopisch resezierbaren und damit kurativ therapierbaren Stadien hat zugenommen. Auch Tumoren des oberen Gastrointestinaltrakts werden zunehmend im endoskopisch therapierbaren Stadium diagnostiziert, wobei hier auch verbesserte technische Möglichkeiten dazu beigetragen haben, dass zunehmend mehr Läsionen endoskopisch reseziert werden.

Die aktuellen Leitlinien zu Diagnostik und Therapie von Plattenepithelkarzinomen und Adenokarzinomen des Ösophagus, Magen- und Kolonkarzinom definieren genau, welche Tumore kurativ endoskopisch therapierbar sind. Dies hängt vom lymphogenen Metastasierungsrisiko ab, das durch bestimmte, von der Tumorlokalisation abhängige, histopathologische Charakteristika abgeschätzt werden kann. Im Wesentlichen handelt es sich um die am endoskopischen Resektat erfassbare Infiltrationstiefe und den Resektionsrandstatus nach endoskopischer Therapie sowie den Tumorsubtyp und das histologische Grading. Additiv ist eine Infiltration in Lymph- und Blutgefäße zu berücksichtigen.

Abstract

Since the implementation of a nationwide screening colonoscopy the incidence of colorectal adenocarcinoma is decreasing, while the amount of early endoscopically resectable tumours is increasing. Similarly malignant tumors of the upper gastrointestinal tract are diagnosed and resected endoscopically more often. In part, this also depends on improvements in technology.

The current guidelines of diagnosis and treatment of squamous carcinoma and adenocarcinoma of the esophagus, gastric cancer and colorectal cancer exactly define, which lesions can be endoscopically resected curatively. This mostly depends on the risc of metastases in regional lymph nodes. The risc of a lymphatic spread can be asessed by histopathological characteristics depending on the localisation of the lesion. Substantially, these characteristics comprise the depth of invasion in the resection specimen and the status at the resection margins after the endoscopic resection as well as the tumor subtype and the histological grading of the tumor. In addition, an infiltration in lymphatic or blood vessels has to be taken into account.

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