Double-Tract-Rekonstruktion nach Resektion des gastroösophagealen Übergangs wegen AEG-II- und -III-Tumoren

Zusammenfassung

Bei selektionierten AEG-Typ-II- und -III-Tumoren (AEG = Adenokarzinome des ösophagogastralen Übergangs) der T-Kategorien 1 und 2 kann der distawle Magen nach proximaler Resektion ohne Beeinträchtigung der Radikalität und der Prognose erhalten werden. Als Rekonstruktion wird die Doppeltraktanlage mit Seit-zu-Seit-Anastomosierung des distalen Magens in die Roux-Y-Jejunumschlinge nach Ösophagojejunostomie dargestellt. Nach der Literatur hat dieses Verfahren eine niedrige Rate von postoperativer Refluxösophagitis, erfordert gegenüber der totalen Gastrektomie signifikant geringere Dosen an Vitamin-B12-Substitution und die Hämoglobinwerte sind signifikant höher.

Abstract

In selected adenocarcinomas of the oesophagogastric junction with AEG types II and III and of T-category 1 and 2, proximal gastric resection with preservation of the distal stomach can be performed without impairment of radicality or prognosis. Double tract reconstruction with side to side anastomosis of the distal stomach to the Roux-en-Y jejunal loop after oesophagojejunostomy is presented. According to the literature, this procedure has a low rate of postoperative reflux oesophagitis and long term effects include significantly lower dosage of vitamin B12 substitution and significantly higher haemoglobin levels than after total gastrectomy.

Schlüsselwörter

Magenkarzinom - Adenokarzinome des ösophagogastralen Übergangs - proximale Magenresektion - Double-Tract-Rekonstruktion - Vitamin B12

Key words

gastric cancer - adenocarcinoma of the esophagogastric junction - proximal gastrectomy - double tract reconstruction - vitamin B12

Publication History

Article published online:
02 November 2020

• Literatur

• 1 Hölscher AH, Gockel I, Porschen R. Aktualisierte S3-Leitlinie zum Ösophaguskarzinom und Ergänzungen aus chirurgischer Sicht. Chirurg 2019
• 2 Moehler M, Al-Batran SE, Andus T. et al S3-Leitlinie Diagnostik und Therapie des Magenkarzinoms. 2012 Im Internet (Stand 15.04.2019): https://www.leitlinienprogramm-onkologie.de/leitlinien/magenkarzinom
• 3 Haverkamp L, Seesing ME, Ruurda JP. et al Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus 2017; 30: 1-7
• 4 Siewert R, Feith M, Werner M. et al Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1002 consecutive patients. Ann Surg 2000; 232: 353-361
• 5 Siewert JR, Hölscher AH, Becker K. et al Kardiakarzinom: Versuch einer therapeutisch relevanten Klassifikation. Chirurg 1987; 58: 225-234
• 6 Siewert JR, Stein H, Feith M. Adenocarcinoma of the esophago-gastric junction. Scand J Surgery 2006; 95: 260-269 . doi:10.1177/145749690609500409
• 7 Nishi M, Kajisa T, Akune T. et al Cardia cancer proposal of cancer in the esophagogastric junction. Geka Shinryo (Surgical Diagnosis and Treatment) 1973; 15: 1328-1338
• 8 Japan Esophageal Society. Japanese Classification of Esophageal Cancer. 11^th Edition, part II and III. Esophagus 2017; 14: 37-65
• 9 Yamashita H, Seto Y, Sano T. et al Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer 2017; 20 (Suppl. 01) S69-S83
• 10 Kitagawa Y. JGCA und JES 2018. Prospektive Studie zur Lymphknotenmetastasierung bei Karzinomen des ösophagogastralen Übergangs (2018). Abstract JSGS Congress Kagoshima 2018. Persönliche Mitteilung 13.07.2018.
• 11 Kim MC, Kim KH, Jung GJ. et al Comparative study of complete and partial omentectomy in radical subtotal gastrectomy for early gastric cancer. Yonsei Med J 2011; 52: 961-966
• 12 Jongerius EJ, Boerma D, Seldenrijk KA. et al Role of omentectomy as part of radical surgery for gastric cancer. Br J Surg 2016; 103: 1497-1503
• 13 Hölscher AH, Bollschweiler E, Oertli D. Ulcus ventriculi: Operationsindikation und operative Therapie. In: Siewert JR, Harder F, Rothmund M. Hrsg. Praxis der Viszeralchirurgie. Gastroenterologische Chirurgie. Berlin, Heidelberg, New York: Springer; 2002: 361-369
• 14 Aikou T, Natsugoe S, Shimazu H. et al Antrum preserving double tract method for reconstruction following proximal gastrectomy. Jpn J Surg 1988; 18: 114-115
• 15 Jung DH, Ahn SH, Park DJ. et al Proximal gastrectomy for gastric cancer. J Gastric Cancer 2015; 15: 77-86
• 16 Stein HJ, Feith M, Mueller J. et al Limited resection for early adenocarcinoma in Barrettʼs esophagus. Ann Surg 2000; 232: 733-742
• 17 Gutschow C, Schröder W, Hölscher AH. Merendino procedure with preservation of the vagus for early carcinoma of the gastroesophageal junction. Zentralbl Chir 2004; 129: 276-281
• 18 Zapletal C, Heesen C, Origer J. et al Quality of life after surgical treatment of early Barrettʼs cancer: a prospective comparison of the Ivor-Lewis resection versus the modified Merendino resection. World J Surg 2014; 38: 1444-1452 . doi:10.1007/s00268-013-2410-1
• 19 Grotenhuis BA, Wijnhoven BP, Poley JVV. et al Preoperative assessment of tumor location and station-specific lymph node status in patients with adenocarcinoma of the gastroesophageal junction. World J Surg 2013; 37: 147-155
• 20 Ahn SH, Jung DH, Son SY. et al Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer 2014; 17: 562-570
• 21 Jung DH, Lee Y, Kim DW. et al Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer. Surg Endosc 2017; 31: 3961-3969
• 22 Nomura E, Lee SW, Kawai M. et al Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition. World J Surg Oncol 2014; 12: 20 . doi:10.1186/1477-7819-12-20
• 23 Park JY, Park KB, Kwon OK. et al Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy in terms of nutritional status or quality of life in early gastric cancer patients. Eur J Surg Oncol 2018; 44: 1963-1970 . doi:10.1016/j.ejso.2018.08.014
• 24 Cho M, Son T, Kim H. et al Similar hematologic and nutritional outcomes after proximal gastrectomy with double tract reconstruction in comparison to total gastrectomy for early upper gastric cancer. Surg Endosc 2018
• 25 Fein M, Fuchs KH, Thalheimer A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg 2008; 247: 759-765
• 26 KLASS-05. http://klass.or.kr/trial/sub05.html . https://clinicaltrials.gov/ct2/show/NCT02892643; Stand 23.12.2018
• 27 Hölscher AH, Law S. Esophagogastric junction adenocarcinomas: individualization of resection with special considerations for Siewert type II, and Nishi types EG, E=G and GE cancers. Gastric Cancer 2020; 23: 3-9