Download PDF
Allgemein- und Viszeralchirurgie up2date 2024; 18(05): 381-404
DOI: 10.1055/a-2322-4087
Oberer Gastrointestinaltrakt

Therapie des Ösophaguskarzinom

Beat Moeckli
,
Mickael Chevallay
,
Nadja Niclauss
,
Alexandra M. König
,
Jakob R. Izbicki
,
Stefan Paul Mönig
› Further Information
Also available at
    Permissions and Reprints All articles of this category

Das Ösophaguskarzinom weist trotz multimodaler Therapieansätze weiterhin nur geringe 5-Jahres-Überlebensraten von 15–25% auf. Angelehnt an die im Dezember 2023 publizierte 4. Version der S3-Leitlinie sowie die „ESMO Clinical Practice Guidelines“ stellen wir in diesem Artikel Diagnostik, Staging und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus dar.
Kernaussagen

  • Die Diagnostik erfolgt durch Ösophagogastroduodenoskopie mit Biopsien.

  • Für das Staging sind Endosonografie und Computertomografie notwendig.

  • Bei Frühkarzinomen (T1a; ggf. T1b bei Adenokarzinomen) kann eine endoskopische Resektion versucht werden.

  • Bei lokal fortgeschrittenen Karzinomen (T3–4 oder N+) ist eine multimodale Therapie indiziert. Die Immuncheckpoint-Inhibitor-Therapie nimmt hier einen immer größeren Stellenwert ein.

  • Die chirurgische Resektion erfolgt abhängig von der Lokalisation des Tumors. Die Ösophagektomie sollte minimalinvasiv oder in Kombination mit offenen Verfahren (Hybrid-Technik) ausgeführt werden.

  • Eine chirurgische Resektion ist bei präoperativ bekannter Oligometastasierung zurzeit nur im Rahmen von Studien indiziert (RENAISSANCE-Trial).

Schlüsselwörter

oberer Gastrointestinaltrakt - Onkologie - Chemotherapie - Radiotherapie - maligne Erkrankung


Publication History

Article published online:
24 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Morgan E, Soerjomataram I, Rumgay H. et al. The Global Landscape of Esophageal Squamous Cell Carcinoma and Esophageal Adenocarcinoma Incidence and Mortality in 2020 and Projections to 2040: New Estimates From GLOBOCAN 2020. Gastroenterology 2022; 163: 649-658.e2
    CrossrefPubMedSearch in Google Scholar
  • 2 Wolf U, Barnes B, Bertz J. et al. Das Zentrum für Krebsregisterdaten (ZfKD) im Robert Koch-Institut (RKI) in Berlin. Bundesgesundheitsbl 2011; 54: 1229-1234
    CrossrefPubMedSearch in Google Scholar
  • 3 Pennathur A, Gibson MK, Jobe BA. et al. Oesophageal carcinoma. Lancet 2013; 381: 400-412
    CrossrefPubMedSearch in Google Scholar
  • 4 Bollschweiler E, Wolfgarten E, Gutschow C. et al. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001; 92: 549-555
    CrossrefPubMedSearch in Google Scholar
  • 5 Steevens J, Botterweck AAM, Dirx MJM. et al. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 2010; 22: 669-678
    CrossrefPubMedSearch in Google Scholar
  • 6 Lin Y, Wang HL, Fang K. et al. International trends in esophageal cancer incidence rates by histological subtype (1990–2012) and prediction of the rates to 2030. Esophagus 2022; 19: 560-568
    CrossrefPubMedSearch in Google Scholar
  • 7 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7-30
    CrossrefPubMedSearch in Google Scholar
  • 8 Nucci D, Marino A, Realdon S. et al. Lifestyle, WCRF/AICR Recommendations, and Esophageal Adenocarcinoma Risk: A Systematic Review of the Literature. Nutrients 2021; 13: 3525
    CrossrefPubMedSearch in Google Scholar
  • 9 Porschen R, Langer T, van Leeuwen P. Leitlinienreport der S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. Z Gastroenterol 2023; 61: e308-e346
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Obermannová R, Alsina M, Cervantes A. et al. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33: 992-1004
    CrossrefPubMedSearch in Google Scholar
  • 11 Mönig SP, Zirbes TK, Schröder W. et al. Staging of gastric cancer: correlation of lymph node size and metastatic infiltration. Am J Roentgenol 1999; 173: 365-367
    CrossrefPubMedSearch in Google Scholar
  • 12 Kutup A, Nentwich MF, Bollschweiler E. et al. What Should Be the Gold Standard for the Surgical Component in the Treatment of Locally Advanced Esophageal Cancer: Transthoracic Versus Transhiatal Esophagectomy. Ann Surg 2014; 260: 1016-1022
    CrossrefPubMedSearch in Google Scholar
  • 13 Alakus H, Batur M, Schmidt M. et al. Variable 18F-fluorodeoxyglucose uptake in gastric cancer is associated with different levels of GLUT-1 expression. Nucl Med Commun 2010; 31: 532-538
    CrossrefPubMedSearch in Google Scholar
  • 14 Mönig S, Ott K, Gockel I. et al. S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs. Chirurg 2020; 91: 37-40
    CrossrefPubMedSearch in Google Scholar
  • 15 Moehler M, Al-Batran SE, Andus T. et al. S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL. Z Gastroenterol 2019; 57: 1517-1632
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg 2017; 6: 119-130
    CrossrefPubMedSearch in Google Scholar
  • 17 Kitagawa Y, Ishihara R, Ishikawa H. et al. Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: part 2. Esophagus 2023; 20: 373-389
    CrossrefPubMedSearch in Google Scholar
  • 18 Siewert JR, Stein HJ, Böttcher K. Lymphadenektomie bei Tumoren des oberen Gastrointestinaltrakts. Chirurg 1996; 67: 877-888
    CrossrefPubMedSearch in Google Scholar
  • 19 Cao Y, Liao C, Tan A. et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Hodari A, Hammoud ZT, Borgi JF. et al. Assessment of Morbidity and Mortality After Esophagectomy Using a Modified Frailty Index. Ann Thorac Surg 2013; 96: 1240-1245
    CrossrefPubMedSearch in Google Scholar
  • 21 Derogar M, Sadr-Azodi O, Johar A. et al. Hospital and surgeon volume in relation to survival after esophageal cancer surgery in a population-based study. J Clin Oncol 2013; 31: 551-557
    CrossrefPubMedSearch in Google Scholar
  • 22 van der Werf LR, Busweiler LAD, van Sandick JW. et al. Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG). Ann Surg 2020; 271: 1095-1101
    CrossrefPubMedSearch in Google Scholar
  • 23 Lang H, Grimminger PP, Meyer HJ. Mindestmengenregelungen in der Chirurgie aus Sicht der Fachgesellschaft (DGCH). Chirurg 2022; 93: 342-348
    CrossrefPubMedSearch in Google Scholar
  • 24 Hölscher AH, Stahl M, Messmann H. et al. Die neue S3-Leitlinie zum Ösophaguskarzinom: Wichtige chirurgische Aspekte. Chirurg 2016; 87: 865-872
    CrossrefPubMedSearch in Google Scholar
  • 25 Omloo JMT, Lagarde SM, Hulscher JBF. et al. Extended Transthoracic Resection Compared With Limited Transhiatal Resection for Adenocarcinoma of the Mid/Distal Esophagus: Five-Year Survival of a Randomized Clinical Trial. Ann Surg 2007; 246: 992-1001
    CrossrefPubMedSearch in Google Scholar
  • 26 Squires MH, Kooby DA, Poultsides GA. et al. Is it time to abandon the 5-cm margin rule during resection of distal gastric adenocarcinoma? A multi-institution study of the U.S. Gastric Cancer Collaborative. Ann Surg Oncol 2015; 22: 1243-1251
    CrossrefPubMedSearch in Google Scholar
  • 27 Postlewait LM, Squires MH, Kooby DA. et al. The importance of the proximal resection margin distance for proximal gastric adenocarcinoma: A multi-institutional study of the US Gastric Cancer Collaborative. J Surg Oncol 2015; 112: 203-207
    CrossrefPubMedSearch in Google Scholar
  • 28 Sasako M, Sano T, Yamamoto S. et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol 2006; 7: 644-651
    CrossrefPubMedSearch in Google Scholar
  • 29 Fuchs H, Hölscher AH, Leers J. et al. Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy?. Gastric Cancer 2015; 19: 312-317
    CrossrefPubMedSearch in Google Scholar
  • 30 Biere SS, van Berge Henegouwen MI, Maas KW. et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379: 1887-1892
    CrossrefPubMedSearch in Google Scholar
  • 31 Reeh M, Mina S, Bockhorn M. et al. Staging and outcome depending on surgical treatment in adenocarcinomas of the oesophagogastric junction. Br J Surg 2012; 99: 1406-1414
    CrossrefPubMedSearch in Google Scholar
  • 32 Peyre CG, Hagen JA, DeMeester SR. et al. The Number of Lymph Nodes Removed Predicts Survival in Esophageal Cancer: An International Study on the Impact of Extent of Surgical Resection. Ann Surg 2008; 248: 549-556
    CrossrefPubMedSearch in Google Scholar
  • 33 Koenig AM, Prenzel KL, Bogoevski D. et al. Strong Impact of Micrometastatic Tumor Cell Load in Patients with Esophageal Carcinoma. Ann Surg Oncol 2008; 16: 454-462
    CrossrefPubMedSearch in Google Scholar
  • 34 Stephens EH, Gaur P, Hotze KO. et al. Super-Charged Pedicled Jejunal Interposition Performance Compares Favorably With a Gastric Conduit After Esophagectomy. Ann Thorac Surg 2015; 100: 407-413
    CrossrefPubMedSearch in Google Scholar
  • 35 Luketich JD, Pennathur A, Awais O. et al. Outcomes After Minimally Invasive Esophagectomy: Review of Over 1000 Patients. Ann Surg 2012; 256: 95-103
    CrossrefPubMedSearch in Google Scholar
  • 36 Müller-Stich BP, Probst P, Nienhüser H. et al. Meta-analysis of randomized controlled trials and individual patient data comparing minimally invasive with open oesophagectomy for cancer. Br J Surg 2021; 108: 1026-1033
    CrossrefPubMedSearch in Google Scholar
  • 37 Briez N, Piessen G, Bonnetain F. et al. Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial – the MIRO trial. BMC Cancer 2011; 11: 310
    CrossrefPubMedSearch in Google Scholar
  • 38 Nuytens F, Dabakuyo-Yonli TS, Meunier B. et al. Five-Year Survival Outcomes of Hybrid Minimally Invasive Esophagectomy in Esophageal Cancer: Results of the MIRO Randomized Clinical Trial. JAMA Surg 2021; 156: 323-332
    CrossrefPubMedSearch in Google Scholar
  • 39 Brierley RC, Gaunt D, Metcalfe C. et al. Laparoscopically assisted versus open oesophagectomy for patients with oesophageal cancer – the Randomised Oesophagectomy: Minimally Invasive or Open (ROMIO) study: protocol for a randomised controlled trial (RCT). BMJ Open 2019; 9: e030907
    CrossrefPubMedSearch in Google Scholar
  • 40 van Boxel GI, Kingma BF, Voskens FJ. et al. Robotic-assisted minimally invasive esophagectomy: past, present and future. J Thorac Dis 2020; 12: 54-62
    CrossrefPubMedSearch in Google Scholar
  • 41 van der Sluis PC, Babic B, Uzun E. et al. Robot-assisted and conventional minimally invasive esophagectomy are associated with better postoperative results compared to hybrid and open transthoracic esophagectomy. Eur J Surg Oncol 2022; 48: 776-782
    CrossrefPubMedSearch in Google Scholar
  • 42 van der Sluis PC, van der Horst S, May AM. et al. Robot-assisted Minimally Invasive Thoracolaparoscopic Esophagectomy Versus Open Transthoracic Esophagectomy for Resectable Esophageal Cancer: A Randomized Controlled Trial. Ann Surg 2019; 269: 621
    CrossrefPubMedSearch in Google Scholar
  • 43 Park S, Hwang Y, Lee HJ. et al. Comparison of robot-assisted esophagectomy and thoracoscopic esophagectomy in esophageal squamous cell carcinoma. J Thorac Dis 2016; 8: 2853-2861
    CrossrefPubMedSearch in Google Scholar
  • 44 Al-Batran SE, Goetze TO, Mueller DW. et al. The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction – a phase III trial of the German AIO/CAO-V/CAOGI. BMC Cancer 2017; 17: 893
    CrossrefPubMedSearch in Google Scholar
  • 45 Al-Batran SE, Homann N, Pauligk C. et al. Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial. JAMA Oncol 2017; 3: 1237-1244
    CrossrefPubMedSearch in Google Scholar
  • 46 Cunningham D, Allum WH, Stenning SP. et al. Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer. N Engl J Med 2006; 355: 11-20
    CrossrefPubMedSearch in Google Scholar
  • 47 Al-Batran SE, Homann N, Pauligk C. et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019; 393: 1948-1957
    CrossrefPubMedSearch in Google Scholar
  • 48 van Hagen P, Hulshof MC, van Lanschot JJ. et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012; 366: 2074-2084
    CrossrefPubMedSearch in Google Scholar
  • 49 Hoeppner J, Lordick F, Brunner T. et al. ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer 2016; 16: 503
    CrossrefPubMedSearch in Google Scholar
  • 50 Shapiro J, van Lanschot JJB, Hulshof MCCM. et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015; 16: 1090-1098
    CrossrefPubMedSearch in Google Scholar
  • 51 Pöttgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer – A meta-analysis of the randomized trials. Cancer Treat Rev 2012; 38: 599-604
    CrossrefPubMedSearch in Google Scholar
  • 52 Hölscher AH, Bollschweiler E, Bogoevski D. et al. Prognostic impact of neoadjuvant chemoradiation in cT3 oesophageal cancer – A propensity score matched analysis. Eur J Cancer 2014; 50: 2950-2957
    CrossrefPubMedSearch in Google Scholar
  • 53 Chiu CH, Chao YK, Chang HK. et al. Interval between neoadjuvant chemoradiotherapy and surgery for esophageal squamous cell carcinoma: does delayed surgery impact outcome?. Ann Surg Oncol 2013; 20: 4245-4251
    CrossrefPubMedSearch in Google Scholar
  • 54 Markar S, Gronnier C, Duhamel A. et al. Salvage Surgery After Chemoradiotherapy in the Management of Esophageal Cancer: Is It a Viable Therapeutic Option?. J Clin Oncol 2015; 33: 3866-3873
    CrossrefPubMedSearch in Google Scholar
  • 55 Götze T, Schiffmann L, Al-Batran SE. et al. Therapiekonzepte beim metastasierten Magenkarzinom. Allgemein- und Viszeralchirurgie up2date 2017; 11: 67-80
    Thieme ConnectSearch in Google Scholar
  • 56 Webb A, Cunningham D, Scarffe JH. et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997; 15: 261-267
    CrossrefPubMedSearch in Google Scholar
  • 57 Al-Batran SE, Hartmann JT, Hofheinz R. et al. Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol 2008; 19: 1882-1887
    CrossrefPubMedSearch in Google Scholar
  • 58 Bang YJ, Van Cutsem E, Feyereislova A. et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687-697
    CrossrefPubMedSearch in Google Scholar
  • 59 Janjigian YY, Shitara K, Moehler M. et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial. Lancet 2021; 398: 27-40
    CrossrefPubMedSearch in Google Scholar
  • 60 Sun JM, Shen L, Shah MA. et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. Lancet 2021; 398: 759-771
    CrossrefPubMedSearch in Google Scholar
  • 61 Kondrup J. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22: 415-421
    CrossrefPubMedSearch in Google Scholar
  • 62 Hennessey DB, Burke JP, Ni-Dhonochu T. et al. Preoperative Hypoalbuminemia is an Independent Risk Factor for the Development of Surgical Site Infection Following Gastrointestinal Surgery: A Multi-Institutional Study. Ann Surg 2010; 252: 325-329
    CrossrefPubMedSearch in Google Scholar
  • 63 Weimann A, Braga M, Carli F. et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017; 36: 623-650
    CrossrefPubMedSearch in Google Scholar
  • 64 Baiocchi GL, D’Ugo D, Coit D. et al. Follow-up after gastrectomy for cancer: the Charter Scaligero Consensus Conference. Gastric Cancer 2015; 19: 15-20
    CrossrefPubMedSearch in Google Scholar