Technik und Studienlage der laparoskopischen Gastrektomie bei Magenkarzinom

Zusammenfassung

Hintergrund

Ziel dieser Arbeit war es, die Technik einer laparoskopischen Gastrektomie bei Magenkarzinom darzustellen sowie in einem Review die aktuelle internationale Studienlage zu diesem Thema zusammenzufassen.

Materialien und Methoden

Im 1. Teil wird eine laparoskopische Standardgastrektomie bei Karzinom beschrieben und dokumentiert. Im 2. Teil werden nach einer EMBASE- und PubMed-Suche aus primär 3042 Treffern durch systematisches Eingrenzen insgesamt 123 qualitätsrelevante randomisierte (RCT) und nicht randomisierte (non-RCT) Studien zur laparoskopischen Gastrektomie identifiziert. Danach werden die Studienergebnisse konklusiv für die Zielkriterien Durchführbarkeit, Outcome, onkologische Qualität sowie Morbidität und Mortalität zusammengefasst.

Ergebnisse

Sowohl die laparoskopisch subtotale Resektion bei distalen Magenkarzinomen wie auch die laparoskopische Gastrektomie sind inzwischen sicher und komplikationsarm durchführbar. In einem aktuellen Literaturreview über insgesamt 15 RCT mit 5576 Patienten (laparoskopisch 2793 vs. offen 2756) ergaben sich keine signifikanten Unterschiede in Bezug auf Durchführbarkeit, intraoperatives Outcome und onkologische Qualität (R0-Status und Lymphknotenausbeute). Die chirurgische Morbidität und Mortalität waren vergleichbar. Patienten nach laparoskopischer Operation zeigten eine signifikant schnellere frühpostoperative Erholung mit einer geringeren Gesamtmorbidität. Im Gegensatz dazu war die Operationszeit im Vergleich zur offenen Technik um durchschnittlich 45 min signifikant verlängert. Die Vorteile der laparoskopischen Technik bildeten sich in Studien zum Magenfrühkarzinom und bei fortgeschrittenen Karzinomen (>T2) gleichermaßen ab.

Schlussfolgerung

Die laparoskopische Gastrektomie bei Magenkarzinom ist sicher durchführbar und zeigt eine bessere frühpostoperative Erholung. Komplikationsraten, Morbidität und Mortalität sowie onkologische Langzeitergebnisse sind mit der offenen Chirurgie vergleichbar.

Abstract

Background

The aim of this paper was to describe the technique of laparoscopic gastrectomy for gastric carcinoma and to present a review of current international studies on this topic.

Materials and Methods

The first part describes and documents a standard laparoscopic gastrectomy for carcinoma. In the second part, after an EMBASE and PubMed search, a total of 123 quality-relevant randomised (RCT) and non-randomised (non-RCT) studies on laparoscopic gastrectomy are identified from a primary total of 3,042 hits by systematic narrowing. The study results are then summarised conclusively for the target criteria of feasibility, outcome, oncological quality, morbidity and mortality.

Results

Both, laparoscopic subtotal resection for distal gastric carcinomas and laparoscopic gastrectomy can now be performed safely and with few complications. In a recent literature review of a total of 15 RCTs with 5,576 patients (laparoscopic 2,793 vs. open 2,756), there were no significant differences in terms of feasibility, intraoperative outcome and oncological quality (R0 and lymph node harvest). Surgical morbidity and mortality were comparable. Patients after laparoscopic surgery showed a significantly faster early postoperative recovery with a lower overall morbidity. In contrast, the operating time was significantly longer – by a mean of 45 min – compared to the open technique. The advantages of the laparoscopic technique were equally evident in studies on early gastric carcinoma and advanced carcinomas (>T2).

Conclusion

Laparoscopic gastrectomy for gastric carcinoma is safe to perform and shows better early postoperative recovery. Complication rates, morbidity and mortality as well as long-term oncological results are comparable with open surgery.

Schlüsselwörter

laparoskopische Gastrektomie - Magenkarzinom - Review

Keywords

laparoscopic gastrectomy - gastric cancer - review

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