Subscribe to RSS
DOI: 10.1055/s-0029-1224534
© Georg Thieme Verlag Stuttgart ˙ New York
Diagnostik und Therapie des Magenkarzinoms – Workflow
Diagnosis of and Therapy for Gastric Cancer – Work-FlowPublication History
Publication Date:
17 August 2009 (online)
![](https://www.thieme-connect.de/media/zblchir/200904/lookinside/thumbnails/10.1055-s-0029-1224534-1.jpg)
Zusammenfassung
Hintergrund: In dieser Übersicht wird zur Diagnostik und Therapie des Magenkarzinoms im engeren Sinn – Karzinome des ösophagogastralen Übergangs sind ausgenommen – Stellung genommen und ein diagnostischer und therapeutischer Algorithmus in Abhängigkeit vom Tumorstadium vorgestellt. Präoperative Diagnostik: Neben der Endoskopie hat die Endosonografie für die Bestimmung der T-Kategorie und als Selektionskriterium zur neoadjuvanten Chemotherapie ihren festen Platz, bei Tumoren > T1 zusätzlich das CT. Die Staginglaparoskopie wird für T3- und T4-Tumoren empfohlen, da sich so explorative Laparotomien vermeiden und die Genauigkeit der Metastasendiagnostik erhöhen lassen. Therapie: Lokale Therapieverfahren (endoskopische Mukosaresektion und endoskopische Submukosadissektion) sind für reine Mukosakarzinome (T1 a oder intraepitheliale Neoplasien / kein Ulkus / G1, 2 / Laurén intestinal / L0 / V0 / Tumorgröße ≤ 2 cm) indiziert. Bei allen anderen Tumoren ist die Gastrektomie bzw. bei distalen Karzinomen die subtotale Magenresektion indiziert, Standard ist die D2-Lymphadenektomie ohne Pankreaslinksresektion und ohne Splenektomie. Zur Rekonstruktion nach Magenresektion wird mehrheitlich die Roux-Y-Rekonstruktion empfohlen, Pouch und Wiederherstellung der Duodenalpassage durch Jejunuminterponat kommen nur für Patienten mit guter Prognose in Betracht. Erweiterte Resektionen sind beim Magenkarzinom nur bei möglicher R0-Resektion indiziert. Die Resektion von metachronen oder synchronen Lebermetastasen kann nur in Ausnahmefällen erwogen werden, da ca. 50 % aller Patienten mit Lebermetastasen auch eine Peritonealkarzinose aufweisen. Diskussion und Schlussfolgerung: Die Operation in Zentren führt zu besseren perioperativen Ergebnissen und auch zu einer verbesserten Prognose. Die Datenlage ist jedoch schwierig zu bewerten, da Zentren anhand der Fallzahlen definiert werden und klare Grenzwerte nicht angegeben werden können. Neoadjuvante Chemotherapie und adjuvante Radiochemotherapie gründen sich auf den MAGIC und MacDonald-Studien. Die neoadjuvante Chemotherapie sollte bei cT3- und cT4-Tumoren durchgeführt werden mit dem Ziel, über eine Verkleinerung der Tumormasse (Downsizing) die Voraussetzung für eine R0-Resektion zu verbessern. Es liegen keine ausreichenden Daten vor, die den routinemäßigen Einsatz einer adjuvanten Chemotherapie rechtfertigen. In selektierten Fällen kann aufgrund der MacDonald-Studie bei nicht ausreichender Lymphknotendissektion und fraglicher R0-Resektion die postoperative Radiochemotherapie erwogen werden.
Abstract
Aim: This review comments on the diagnosis and treatment of gastric cancer in the classical meaning – excluding adenocarcinoma of the oesophagogastric junction. Algorithms of diagnosis and care with respect to tumour stage are presented. Preoperative Diagnosis: Besides oesophagogastroduodenoscopy, endoscopic ultrasonography is necessary for the accurate diagnosis of T categories and as a selection criterion for neoadjuvant chemotherapy. Computed tomography is recommended for preoperative evaluation of tumours > T1, laparoscopy has become an effective staging tool in T3 and T4 tumours avoiding unnecessary laparotomies and improving the detection of small liver and peritoneal metastases. Treatment: Endoscopic mucosal resection and submucosal dissection are indicated in superficial cancer confined to the mucosa with special characteristics (T1 a / no ulcer / G1, 2 / Laurén intestinal / L0 / V0 / tumour size < 2 cm). In all other cases total gastrectomy or distal subtotal gastric resection are indicated, the latter in cases of tumours located in the distal two-thirds of the stomach. Standard lymphadenectomy (LAD) is the D2 LAD without distal pancreatectomy and splenectomy. The Roux-en-Y oesophagojejunostomy is still the preferred type of reconstruction. An additional pouch reconstruction should be considered in patients with favourable prognosis, this also applies for the preservation of the duodenal passage by jejunum interposition. Extended organ resections are only indicated in cases where a R0-resection is possible. Hepatic resection for metachronous or synchronous liver metastases is rarely advised since 50 % of patients with liver metastases show concomitant peritoneal dissemination of the disease. Discussion and Conclusions: Undergoing gastrectomy at a high-volume centre is associated with lower in-hospital mortality and a better prognosis, however, clear thresholds for case load cannot be given. Perioperative chemotherapy and postoperative chemoradiotherapy are based on the MAGIC and MacDonald trials. Perioperative chemotherapy should be performed in patients with T3 and T4 tumours with the aim to increase the likelihood of curative R0-resection by downsizing the tumour. Adjuvant postoperative chemotherapy cannot be recommended since its benefit has so far not been proven in randomised trials. In selected patients with incomplete lymph-node dissection and questionable R0-resection postoperative chemoradiotherapy may be debated.
Schlüsselwörter
Magenkarzinom - Diagnostik - Lymphknotendissektion - Magenresektion - Workflow
Key words
gastric cancer - diagnosis - lymph-node dissection - gastrectomy - work-flow
Literatur
- 1 Ahn H S, Lee H J, Yoo M W et al. Diagnostic accuracy of T and N stages with endoscopy, stomach protocol CT, and endoscopic ultrasonography in early gastric cancer. J Surg Oncol. 2009; 99 20-27
- 2 Baldus S E, Mönig S P, Schröder W et al. Regression von Ösophaguskarzinomen nach neoadjuvanter Radiochemotherapie. Kriterien der histopathologischen Evaluation. Pathologe. 2004; 25 421-427
- 3 Bhandari S, Shim C S, Kim J H et al. Usefulness of three-dimensional, multidetector row CT (virtual gastroscopy and multiplanar reconstruction) in the evaluation of gastric cancer: a comparison with conventional endoscopy, EUS, and histopathology. Gastrointest Endosc. 2004; 59 619-626
- 4 Bilimoria K Y, Talamonti M S, Wayne J D et al. Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer. Arch Surg. 2008; 143 671-678
- 5 Bilimoria K Y, Bentrem D J, Feinglass J M et al. Directing surgical quality improvement initiatives: comparison of perioperative mortality and long-term survival for cancer surgery. J Clin Oncol. 2008; 26 4626-4633
- 6 Birkmeyer J D, Siewers A E, Finlayson E VA et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002; 346 1128-1137
- 7 Birkmeyer J D, Sun Y, Wong S L et al. Hospital volume and late survival after cancer surgery. Ann Surg. 2007; 245 777-783
- 8 Blackshaw G R, Barry J D, Edwards P et al. Laparoscopy significantly improves the perceived preoperative stage of gastric cancer. Gastric Cancer. 2003; 6 225-229
- 9 Boige V, Pignon J, Saint-Aubert B et al. Final results of a randomized trial comparing preoperative 5-fluorouracil (F) / cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. J Clin Oncol. 2007; 25 (suppl) , ASCO Annual Meeting Procd. Part I, No 18 S
- 10 Bollschweiler E. Scoringsysteme und Qualitätsmanagement. In: Ekkernkamp & Scheibe, Hrsg. Qualitätsmangement in der Medizin: Handbuch für Klinik und Praxis. Landsberg am Lech: Ecomed, 2002: 1–10
- 11 Bollschweiler E, Lübke T, Mönig S P et al. Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy. BMC Surgery. 2005; 5 8
- 12 Bozzetti F, Bonfanti G, Castellani R et al. Comparing reconstruction with Roux-en-Y to a pouch following total gastrectomy. J Am Coll Surg. 1996; 183 243-248
- 13 Bozzetti F, Marubini E, Bonfanti G et al. Subtotal versus total gastrectomy for gastric cancer. Ann Surg. 1999; 230 170-178
- 14 Buzzoni R, Bajetta E, Di Bartolomeo M et al. Pathological features as predictors of recurrence after radical resection of gastric cancer. Br J Surg. 2006; 93 205-209
- 15 Cheon S H, Rha S Y, Jeung H C et al. Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol. 2008; 19 1146-1153
- 16 Copeland G P, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991; 78 355-360
- 17 Cunningham D, Allum W H, Stenning S P et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006; 355 11-20
- 18 Cunningham D, Starling N, Rao S et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008; 358 36-46
- 19 Cunningham D, Oliveira J. ESMO Guidelines Working Group . Gastric cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008; 19 (Suppl 2) ii23-ii24
- 20 Cunningham S C, Schulick R D. Palliative management of gastric cancer. Surg Oncol. 2007; 16 267-275
- 21 Damhuis R A, Meurs C J, Dijkhuis C M et al. Hospital volume and post-operative mortality after resection for gastric cancer. Eur J Surg Oncol. 2002; 28 401-405
- 22 Detsky A S, McLaughlin J R, Baker J P et al. What is subjective global assessment of nutritional status?. JPEN. 1987; 11 8-13
- 23 Drognitz O, Henne K, Weissenberger C et al. Long-term results after intraoperative radiation therapy for gastric cancer. Int J Radiat Oncol Biol Phys. 2008; 70 715-721
- 24 Düx M, Grenacher L, Lubienski A et al. Das Magenkarzinom – Stellenwert der bildgebenden Verfahren für Primärdiagnose und präoperatives Tumorstaging. Röfo. 2000; 172 661-669
- 25 Enzinger P C, Benedetti J K, Meyerhardt J A et al. Impact of hospital volume on recurrence and survival after surgery for gastric cancer. Ann Surg. 2007; 245 426-434
- 26 Fein M, Fuchs K H, Thalheimer A et al. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg. 2008; 247 759-765
- 27 Finlayson E VA, Goodney P P, Birkmeyer J D. Hospital volume and operative mortality in cancer surgery. Arch Surg. 2003; 138 721-725
- 28 Fujisaki S, Tomita R, Nezu T et al. Prognostic studies on gastric cancer with concomitant liver metastases. Hepatogastroenterology. 2001; 48 892-894
- 29 de Gara C J, Hanson J, Hamilton S. A population-based study of tumor-node relationship, resection margins, and surgeon volume on gastric cancer survival. Am J Surg. 2003; 186 23-27
- 30 Gockel I, Pietzka S, Junginger T. Lebensqualität nach subtotaler Magenresektion und Gastrektomie beim Magenkarzinom. Chirurg. 2005; 76 250-257
- 31 Gordon T A, Bowman H M, Bass E B et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg. 1999; 189 46-56
- 32 Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007; 10 1-11
- 33 de Graaf G W, Ayantunde A A, Parsons S L et al. The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol. 2007; 33 988-992
- 34 Gretschel S, Bembenek A, Hünerbein M et al. Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007; 14 2028-2035
- 35 Grundmann R T. Was gibt es Neues in der präoperativen Risikoabschätzung?. In: Messmer, Jähne, Neuhaus, Hrsg. Was gibt es Neues in der Chirurgie? Landsberg / Lech: Ecomed; 2006
- 36 Harmon R L, Sugarbaker P H. Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer. Int Sem. Surg Oncol. 2005; 2 3
- 37 Hartgrink H H, Putter H, Klein Kranenbarg E et al. Value of palliative resection in gastric cancer. Br J Surg. 2002; 89 1438-1443
- 38 Hartgrink H H, van de Velde C J, Putter H et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch Gastric Cancer Group Trial. J Clin Oncol. 2004; 22 2069-2077
- 39 Hartgrink H H, van de Velde C J. Status of extended lymph node dissection: locoregional control is the only way to survive gastric cancer. J Surg Oncol. 2005; 90 153-165
- 40 Hori Y SAGES Guidelines Committee. Diagnostic laparoscopy guidelines. Surg Endosc. 2008; 22 1353-1383
- 41 Huscher C GS, Mingoli A, Sgarzini G et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer. Five-year results of a randomized prospective trial. Ann Surg. 2005; 241 232-237
- 42 Iivonen M K, Mattila J J, Nordback I H et al. Long-term follow-up of patients with jejunal pouch reconstruction after total gastrectomy. A randomized prospective study. Scand J Gastroenterol. 2000; 35 679-685
- 43 Ikeda Y, Saku M, Kishihara F et al. Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer. Br J Surg. 2005; 92 235-239
- 44 Jentuschura D, Winkler M, Strohmeier N et al. Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection. Hepatogastroenterology. 1997; 44 1137-1142
- 45 Jiang Z W, Li J S, Wang Z M et al. The safety and efficiency of fast track surgery in gastric cancer patients undergoing D2 gastrectomy. Zhonghua Wai Ke Za Zhi. 2007; 45 1314-1317
- 46 Kalmar K, Nemeth J, Kelemen A et al. Postprandial gastrointestinal hormone production is different, depending on the type of reconstruction following total gastrectomy. Ann Surg. 2006; 243 465-471
- 47 Kasakura Y, Fujii M, Mochizuki F et al. Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer?. Am J Surg. 2000; 179 237-242
- 48 Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997; 78 606-617
- 49 Kehlet H, Wilmore D W. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008; 248 189-198
- 50 Kim J, Lee J, Hyung W J et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004; 8 727-732
- 51 Kitabatake S, Niwa Y, Miyahara R et al. Confocal endomicroscopy for the diagnosis of gastric cancer in vivo. Endoscopy. 2006; 38 1110-1114
- 52 Kitano S, Shiraishi N, Uyama I et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007; 245 68-72
- 53 Kobayashi A, Nakagohri T, Konishi M et al. Aggressive surgical treatment for T4 gastric cancer. J Gastrointest Surg. 2004; 8 464-470
- 54 Kodera Y, Ito S, Yamamura Y et al. Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol. 2003; 10 898-902
- 55 Kodera Y, Nakanishi H, Ito S et al. Prognostic significance of intraperitoneal cancer cells in gastric carcinoma: detection of cytokeratin 20 mRNA in peritoneal washes, in addition to detection of carcinoembryonic antigen. Gastric Cancer. 2005; 8 142-148
- 56 Koga R, Yamamoto J, Ohyama S et al. Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors. Jpn J Clin Oncol. 2007; 37 836-842
- 57 Kono K, Iizuka H, Sekikawa T et al. Improved quality of life with jejunal pouch reconstruction after total gastrectomy. Am J Surg. 2003; 185 150-154
- 58 Kumar M, Yang S B, Jaiswal V K et al. Is prophylactic placement of drains necessary after subtotal gastrectomy?. World J Gastroenterol. 2007; 13 3738-3741
- 59 Kwok C M, Wu C W, Lo S S et al. Survival of gastric cancer with concomitant liver metastases. Hepatogastroenterology. 2004; 51 1527-1530
- 60 Lassen K, Dejong C H, Ljungqvist O et al. Nutritional support and oral intake after gastric resection in five northern European countries. Dig Surg. 2005; 22 346-352
- 61 Lassen K, Kjaeve J, Fetveit T et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial. Ann Surg. 2008; 247 721-729
- 62 Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients – is reconstruction with a reservoir worhtwhile?. Nutrition. 1999; 15 677-682
- 63 Lin S Z, Tong H F, You T et al. Palliative gastrectomy and chemotherapy for stage IV gastric cancer. J Cancer Res Clin Oncol. 2008; 134 187-192
- 64 Liu C-G, Ping L, Yang L et al. Distribution of solitary lymph nodes in primary gastric cancer: a retrospective study and clinical implications. World J Gastroenterol. 2007; 13 4776-4780
- 65 Lübke T, Mönig S P, Schneider P M et al. Korreliert der Charlson-Comorbidity-Index mit dem postoperativen Verlauf bei Patienten mit Magenkarzinom?. Zentralbl Chir. 2003; 128 970-976
- 66 MacDonald J S, Smalley S R, Benedetti J et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001; 345 725-730
- 67 De Manzoni G, Verlato G, Roviello F et al. Subtotal versus total gastrectomy for T3 adenocarcinoma of the antrum. Gastric Cancer. 2003; 6 237-242
- 68 Marchet A, Mocellin S, Ambrosi A et al. The ratio between metastatic and examined lymph nodes (n ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy. Results from an Italian multicentric study in 1 853 patients. Ann Surg. 2007; 245 543-552
- 69 Markus P M, Martell J, Leister I et al. Predicting postoperative morbidity by clinical assessment. Br J Surg. 2005; 92 101-106
- 70 Martin R CG, Jaques D P, Brennan M F et al. Extended local resection for advanced gastric cancer. Increased survival versus increased morbidity. Ann Surg. 2002; 236 159-165
- 71 Memon M A, Khan S, Yunus R M et al. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc. 2008; 22 1781-1789
- 72 Meyer L, Steinert R, Nowak L et al. Prospektive Multizenterstudie zur Chirurgie des Magenkarzinoms – Ein Beitrag zur klinischen Versorgungsforschung. Zentralbl Chir. 2005; 130 97-105
- 73 Meyer L, Ridwelski F, Meyer F et al. Qualitätssicherungsstudie zum Magenkarzinom in Deutschland. Onkologe. 2008; 14 396-402
- 74 Miholic J, Meyer H J, Balks J et al. Einfluss der Rekonstruktionsmethode auf den Ernährungszustand nach Gastrektomie. Chirurg. 1991; 62 300-305
- 75 Mönig S P, Collet P H, Baldus S E et al. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol. 2001; 76 89-92
- 76 Nakamura K, Morisaki T, Sugitani A et al. An early gastric carcinoma treatment strategy based on analysis of lymph node metastasis. Cancer. 1999; 85 1500-1505
- 77 Nakayoshi T, Tajiri H, Matsuda K et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy. 2004; 36 1080-1084
- 78 Nomura E, Tsukuma H, Ajiki W et al. Population-based study of relationship between hospital surgical volume and 5-year survival of stomach cancer patients in Osaka, Japan. Cancer Sci. 2003; 94 998-1002
- 79 Ott K, Fink U, Becker K et al. Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging: results of a prospective trial. J Clin Oncol. 2003; 21 4604-4610
- 80 Pan Y, Li Q, Wang D C et al. Beneficial effects of jejunal continuity and duodenal food passage after total gastrectomy: a retrospective study of 704 patients. Eur J Surg Oncol. 2008; 34 17-22
- 81 De Potter T, Flamen P, Van Cutsem E et al. Whole-body PET with FDG for the diagnosis of recurrent gastric cancer. Eur J Nucl Med Mol Imaging. 2002; 29 525-529
- 82 Reid-Lombardo K M, Gay G, Patel-Parekh L et al. Treatment of gastric adenocarcinoma may differ among hospital types in the United States, a report from the National Cancer Data Base. J Gastrointest Surg. 2007; 11 410-420
- 83 Robert Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg). Krebs in Deutschland 2003–2004. Häufigkeiten und Trends. 6. überarbeitete Auflage. Berlin: 2008
- 84 Sakuramoto S, Sasako M, Yamaguchi T et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007; 357 1810-1820
- 85 Sasako M, Sano T, Yamamoto S et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008; 359 453-462
- 86 Sato Y, Takayama T, Sagawa T et al. Phase II study of S-1, docetaxel and cisplatin combination chemotherapy in patients with unresectable metastatic gastric cancer. J Clin Oncol. 2008; 26 (suppl) , ASCO Annual Meeting, abstr. 4537
- 87 Scottish Intercollegiate Guidelines Network .Management of oesophageal and gastric cancer. A national clinical guideline. 2006
- 88 Shiraishi N, Yasuda K, Kitano S. Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer. 2006; 9 167-176
- 89 Siewert J R, Böttcher K, Stein H J et al. Relevant prognostic factors in gastric cancer. Ten-year results of the German Gastric Cancer Study. Ann Surg. 1998; 228 449-461
- 90 Smith D D, Schwarz R R, Schwarz R E et al. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005; 23 7114-7124
- 91 Smith D L, Elting L S, Learn P A et al. Factors influencing the volume-outcome relationship in gastrectomies: a population-based study. Ann Surg Oncol. 2007; 14 1846-1852
- 92 Smith J K, McPhee J T, Hill J S et al. National outcomes after gastric resection for neoplasm. Arch Surg. 2007; 142 387-393
- 93 Sobin L H, Gospodarowcicz M K, Wittekind C. TNM classification of malignant tumours. 7th ed. New York: Wiley & Sons; 2009
- 94 Suehiro T, Matsumata T, Shikada Y et al. Accelerated rehabilitation with early postoperative oral feeding following gastrectomy. Hepatogastroenterology. 2004; 51 1852-1855
- 95 Tani M, Sakai P, Kondo H. Endoscopic mucosal resection of superficial cancer in the stomach using the cap technique. Endoscopy. 2003; 35 348-355
- 96 Tannapfel A. Histopathologische Besonderheiten von Submukosakarzinomen. Viszeralmedizin. 2009; 25 11-13
- 97 Thelen A, Jonas S, Benckert C et al. Liver resection for metastatic gastric cancer. Eur J Surg Oncol. 2008; 34 1328-1334
- 98 Uedo N, Iishi H, Tatsuta M et al. A novel videoendoscopy system by using autofluorescence and reflectance imaging for diagnosis of esophagogastric cancers. Gastrointest Endosc. 2005; 62 521-528
- 99 van Krieken J HJM, van de Velde C JH. Gastric Cancer. In: Gospodarowicz MK, O’Sullivan B, Sobin H, eds. Prognostic factors in cancer. 3rd ed. New York: Wiley John & Sons; 2006: 129–132
- 100 Wainess R M, Dimick J B, Upchurch Jr G R et al. Epidemiology of surgically treated gastric cancer in the United States, 1988–2000. J Gastrointest Surg. 2003; 7 879-883
- 101 Wang L B, Shen J G, Dong L F et al. Laparoscopic local resection based on sentinel node evaluation for early gastric cancer: a preliminary report. J Gastrointest Surg. 2008; 12 1359-1363
- 102 Weimann A, Braga M, Harsanyi L et al. ESPEN Guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr. 2006; 25 224-244
- 103 Wilke H et al. Magenkarzinom. In: Schmoll JH, Höfken K, Possinger K, Hrsg. Kompendium internistische Onkologie. Heidelberg: Springer; 2006
- 104 Wittekind C, Meyer H-J, Bootz F. UICC: TNM Klassifikation maligner Tumoren. 6. Auflage. Berlin, Heidelberg, New York: Springer; 2002
- 105 Xirasagar S, Lien Y C, Lin H C et al. Procedure volume of gastric cancer resections versus 5-year survival. Eur J Surg Oncol. 2008; 34 23-29
- 106 Yamashita K, Sakuramoto S, Kikuchi S et al. Strong association of lymph node metastasis with intraperitoneal free cancer cell in advanced gastric cancer. Hepatogastroenterology. 2008; 55 1873-1877
- 107 Yan T D, Black D, Sugarbaker P H et al. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol. 2007; 14 2702-2713
- 108 Yang Z, Zheng Q, Wang Z. Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg. 2008; 95 809-816
- 109 Yu W, Choi G S, Chung H Y. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg. 2006; 93 559-563
Prof. R. T. Grundmann
Kreiskliniken Altötting-Burghausen
Krankenhausstr. 1
84489 Burghausen
Germany
Phone: 0 86 77 / 88 05 01
Fax: 0 86 77 / 88 05 03
Email: sek-prof.grundmann@krk-bgh.de