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Oligometastasierung beim Magen- und Ösophaguskarzinom

Aktuelle Studienlage und chirurgische Konzepte

Oligometastases in gastric and esophageal cancer

Current clinical trials and surgical concepts

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Zusammenfassung

Die Rolle der Chirurgie gewinnt auch in metastasierten Tumorstadien zunehmend an Bedeutung. Bei kolorektalen Karzinomen mit einer limitierten Metastasierung kann sowohl in der synchronen als auch metachronen Situation durch eine komplette Tumorresektion ein onkologischer Benefit erzielt werden. Bei den Tumoren des oberen Gastrointestinaltraktes (OGI) ist der Stellenwert der Metastasenchirurgie bisher nicht abschließend geklärt, auch wenn retrospektive Analysen im Kontext einer multimodalen Therapie einen Überlebensvorteil suggerieren. Die aktuelle S3-Leitlinie spricht jedoch auf Basis der bisherigen Datenlage keine Empfehlung für eine chirurgische Therapie aus. Ziel der präoperativen Selektion muss es daher sein, Patienten mit einer vergleichsweise wenig aggressiven Tumorbiologie zu identifizieren. Die Ergebnisse der prospektiv-randomisierten RENAISSANCE/FLOT-5- und GASTRIPEC-Studien werden mit Spannung erwartet, um die Wertigkeit einer Metastasenchirurgie insbesondere auf das Überleben zu definieren.

Abstract

There is an increasing role of surgery even in metastatic tumor stages. In colorectal cancer patients with limited metastases, complete cytoreduction is able to offer long-term survival in synchronic as well as metachronic situations. In tumors of the upper gastrointestinal tract (UGIT), however, the impact of surgery in metastatic disease remains to be clarified. Even though several retrospective studies suggest prolonged survival, surgery is not recommended by the current German S3 guidelines for tumors of the UGIT. Appropriate selection of these particular patients that show less aggressive tumor biology will be the primary goal of preoperative evaluation. The results of the prospective randomized RENAISSANCE/FLOT-5 and GASTRIPEC studies are urgently awaited in order to gain more evidence on the impact of surgery in the management of oligometastases of the UGIT and especially on survival.

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  1. Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    S. Beckert & A. Königsrainer

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Correspondence to S. Beckert.

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S. Beckert und A. Königsrainer geben an, dass kein Interessenkonflikt besteht.

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

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Beckert, S., Königsrainer, A. Oligometastasierung beim Magen- und Ösophaguskarzinom. Chirurg 89, 505–509 (2018). https://doi.org/10.1007/s00104-018-0645-y

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