Tumorchirurgie

Eine wesentliche Säule der gastrointestinalen Onkologie ist die operative Entfernung des Primärtumors und vielfach ebenso die Resektion von Metastasen. Vermehrt erfolgt dies innerhalb multimodaler Konzepte nach Diagnosestellung, aber auch sekundär nach Chemo- oder Strahlentherapie. Dabei kommen, was die chirurgischen Strategien angeht, zum einen Konzepte der Minimalisierung der Operation und zum anderen auch Maximaleingriffe zur Anwendung. In dieser Übersicht wird das Vorgehen bei Frühkarzinomen des Ösophagus und des Magens, aber auch Verfahren bei fortgeschrittenen Tumoren beleuchtet. Ebenso soll die Rationale einer neoadjuvanten Chemotherapie beim Pankreaskarzinom versus der primären Resektion gefolgt von einer adjuvanten Chemotherapie – derzeit nach wie vor der Standard – aufgezeigt werden. Der letzte Abschnitt beschäftigt sich mit nicht resektablen kolorektalen Lebermetastasen, wo sich die Lebertransplantation möglicherweise als neue weitere Option anbieten wird. Gerade letzteres Vorgehen zeigt in einer skandinavischen Pilotstudie exzellente Langzeitergebnisse.

Surgery of the primary tumor and resection of metastasis is an important column in gastrointestinal oncology. Resection as important step in multimodal concepts can be performed either upfront or after neoadjuvant radiotherapy or chemotherapy. Surgical strategies are tailored to the patient and differ between minimal organ preserving approaches to maximal surgical strategies. In this review we focus on the management of early stage gastric and esophageal cancer but also on stage IV disease. Moreover neoadjuvant chemotherapy in pancreatic cancer is compared to upfront resection followed by adjuvant chemotherapy which is the standard procedure up to now. Last but not least we describe the management of non resectable colorectal liver metastasis and the role of liver transplantation as a potential curative option with encouraging results from a Scandinavian pilot study.

Key words

Organ preserving in gastric and esophagus cancer - neoadjuvant chemotherapy for pancreatic cancer - liver transplantation for metastasis

• Literatur

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