Anastomosenprobleme in der Magenchirurgie

Zusammenfassung

Die operative Therapie bietet bei den meisten Patienten mit Magenkarzinom die einzige Aussicht auf Heilung. Durch Verbesserung der Operations- und Anästhesietechnik sowie des Komplikationsmanagements konnte in den letzten Jahren die perioperative Mortalität und Morbidität vermindert werden. Die Anastomoseninsuffizienz nach Magenresektion ist gerade in erfahrenen Zentren eine seltene Komplikation, stellt aber die häufigste Ursache der postoperativen Mortalität dar. Neben der Erfahrung des jeweiligen operativen Zentrums beeinflussen sowohl Lokalisation und Ausdehnung des Tumors als auch das Resektionsausmaß die Inzidenz der Anastomoseninsuffizienz. In dieser Übersichtsarbeit sollen die gängigen Operationsverfahren insbesondere in Hinblick auf Anastomosentechniken und perioperative Komplikationen gegenübergestellt werden.

Abstract

For the most patients with gastric cancer surgery is the only curative treatment. Advances in surgical techniques, perioperative care and management of complications resulted in decreased operative mortality and morbidity. Anastomotic leakage after gastrectomy is a rare complication in specialized centers but the most common cause for hospital mortality. Surgeon's experience, site of the tumor and extent of resection influence the incidence of anastomotic leakage. Herein we review the current surgical procedures with regard to anastomotic complications.

Schlüsselwörter

Magenkarzinom - Anastomoseninsuffizienz - Anastomosenstenose

Key words

gastric carcinoma - anastomotic leakage - anastomotic stenosis

Literatur

• 1 Ekstrom A M, Hansson L E, Signorello L B, Lindgren A, Bergstrom R, Nyren O. Decreasing incidence of both major histologic subtypes of gastric carcinoma - a population-based study in Sweden.  Br J Cancer. 2000;  83 391-396
• 2 Hundahl S A, Menck H R, Mansour E G, Winchester D P. The National Cancer Data Base report on gastric carcinoma.  Cancer. 1997;  80 2333-2341
• 3 Devesa S S, Blot W J, Fraumeni Jr  J F. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States.  Cancer. 1998;  83 2049-2053
• 4 Parkin D, Pisani P, Ferley J. Global cancer statistics.  Ca Cancer J Clin. 1999;  49 33-64
• 5 Macdonald J S, Smalley S R, Bendetti J. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.  N Engl J Med. 2001;  345 725-730
• 6 Cunningham D, Allum W H, Stenning S P, Weedon S. Perioperative chemotherapy in operable gastric and low oesophageal cancer: final results of a randomised controlled trial (the MAGIC trial, ISRCTN 93 793 971).  J Clin Oncol. 2005;  23 3085
• 7 Roeder C. Total gastrectomy.  Ann Surg. 1933;  98 221-231
• 8 Sendler A, Siewert J R. Aktuelle Therapie des Magenkarzinoms.  Dtsch Med Wochenschr. 2000;  125 359-362
• 9 Siewert J R, Stein H J, Bartels H. Insuffizienzen nach Anastomosen im Bereich des oberen Gastrointestinaltraktes.  Chirurg. 2004;  75 1063-1070
• 10 Bonenkamp J J, Songun I, Hermans J, Sasako M, Welvaart K, Plukker J T, van Elk P, Obertop H, Gouma D J, Taat C W. et al . Randomised comparison of morbidity after D 1 and D 2 dissection for gastric cancer in 996 Dutch patients.  Lancet. 1995;  345 745-748
• 11 Roder J D, Bottcher K, Siewert J R, Busch R, Hermanek P, Meyer H J. Prognostic factors in gastric carcinoma. Results of the German Gastric Cancer Study 1992.  Cancer. 1993;  72 2089-2097
• 12 Schlatter C. A unique case of complete removal of the stomach: successful oesophagoenterostomy recovery.  Medical Research. 1897;  52 909-914
• 13 Heberer G, Teichmann R K, Kramling H J, Günther B. Results of gastric resection for carcinoma of the stomach. The European experience.  World J Surg. 1988;  12 374-381
• 14 Hunt C J. Construction of a food pouch from segment of jejunum as substitute for stomach in total gastrectomy.  Arch Surg. 1952;  64 601
• 15 Lawrence C J. Reservoir construction after total gastrectomy.  Ann Surg. 1962;  155 191-198
• 16 Rodino D. Contribution a la technique de l’anastomose aesophago-jejunale après gastrectomie totale.  J Chir. 1952;  68 716-729
• 17 Longmire W P, Beal J M. Construction of a substitute gastric reservoir following total gastrectomy.  Am Surg. 1952;  135 637
• 18 Lee M C. Transposition of a colon segment as a gastric reservoir after total gastrectomy.  Surg Gynecol Obstet. 1951;  92 456-465
• 19 Hunnicutt A J. Replacing stomach after total gastrectomy with right ileocolon.  Arch Surg. 1952;  65 1-11
• 20 Siewert J R, Peiper H J, Jennewein H M, Waldeck F. Esophago-jejunoplication. Technic of anastomosis for prevention of reflux following total gastrectomy.  Chirurg. 1973;  44 115-120
• 21 Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V. et al . Postoperative morbidity and mortality after D 1 and D 2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group.  Lancet. 1996;  347 995-999
• 22 Siewert J R, Böttcher K, Stein H, Roder J D. and the German Gastric Carcinoma Study Group . Relevant prognostic factors in gastric cancer.  Ann Surg. 1998;  228 449-461
• 23 Gockel I, Pietzka S, Gönner U, Hommel G, Junginger T. Subtotal or gastrectomy for gastric cancer: impact of the surgical procedure on morbidity and prognosis - analysis of a 10-year experience.  Langenbecks Arch Surg. 2005;  390 148-155
• 24 Fein M, Fuchs K H, Beese G, Freys S M, Thiede A. Reconstruction modes following gastrectomy. Results of experimental and clinical controlled trials.  Zentrabl Chir. 2001;  1 17-21
• 25 Carrère N, Seulin P, Julio C H, Bloom E, Gouzi J L, Pradère B. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial.  World J Surg. 2007;  31 122-127
• 26 Herfarth C, Schlag P, Buhl K. Surgical procedures for gastric substitution.  World J Surg. 1987;  11 689-698
• 27 Seufert R M. Ösophagojejunostomie: Mechanische Klammernaht versus Handnaht.  Chir Gastroenterol. 1999;  15 253-258
• 28 Gretschel S, Estevez-Schwarz L, Hünerbein M, Schneider U, Schlag P M. Gastric cancer surgery in elderly patients.  World J Surg. 2006;  30 1468-1474
• 29 Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H A, Shimada H. Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients.  Am J Surg. 2006;  191 216-224
• 30 Schubert D, Pross M, Nestler G, Ptok H, Scheidbach H, Fahlke J, Lippert H. Endoskopische Therapieoptionen bei mediastinaler Anastomoseninsuffizienz.  Zentralbl Chir. 2006;  131 369-375
• 31 Rodella L, Laterza E, de Manzoni G, Kind R, Lombardo F, Catalano F, Ricci F, Cordiano C. Endoscopic clipping of anastomotic leakages in esophagogastric surgery.  Endoscopy. 1998;  30 453-456
• 32 Adler D G, McAfee M, Gostout C J. Closure of an esophagopleural fistula by using fistula tract coagulation and an endoscopic suturing device.  Gastrointest Endscop. 2001;  54 652-653
• 33 Sampaio J A, Waechter F L, Pereira-Lima J, Fossati M AM, Felicetti J C, Thiesen V LP, Rostirolla R A, Marques D L, Hornos A P, Pereira-Lima L. Successful treatment of esophagojejunal disconnection after total gastrectomy by insertion of a covered self-expandable esophageal metallic stent.  Gastrointest Endosc. 2003;  58 453-456
• 34 Roy-Choudhury S H, Nicholson A A, Wedgwood K R, Mannion R A, Seman P C, Royston C M, Breen D J. Symptomatic malignant gastro-esophageal anastomotic leak: management with covered metallic stents.  AJR Am J Roentgenol. 2001;  176 161-165
• 35 Lang H, Piso P, Stukenborg C, Raab R, Jähne J. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma.  Eur J Surg Oncol. 2000;  26 168-171
• 36 Mohr V D, Hohenberger W. Anastomosentechniken am Ösophagus. In: Thiede A, Lünstedt B (Hrsg). Standards der Viszerosynthese. Springer, Berlin 1994; 71-85
• 37 Thiede A, Lünenstedt B. Anastomosentechniken im oberen Intestinaltrakt.  Chirurg. 1993;  64 684-689
• 38 Kataoka M, Masaoka A, Hayashi S, Honda H, Hotta T, Niwa T, Honda K. Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy.  Ann Surg. 1989;  209 99-104
• 39 Muehrcke D D, Kaplan D K, Donelly R J. Anastomotic narrowing after esophagogastrectomy with EEA stapling device.  J Thorac Cardiovasc Surg. 1989;  97 434-438
• 40 Wellmann K, Eickmann G, Ulrich B. Qualität der Staplerösophagojejunostomie bei Gastrektomie. In: Thiede A, Lünstedt B (Hrsg). Standards der Viszerosynthese. Springer, Berlin 1994; 86-91
• 41 Tokunaga Y, Ryo J, Kitaoka A, Yagi T, Tokuka A, Ohsumi K. Jejunal pouch to avoid stricture after esophagojejunostomy with circular stapler.  J Am Coll Surg. 1999;  189 466-469
• 42 Hayashi T, Yoshida M, Yoshida K, Nakamura M, Suzuki S, Yamada A, Endo M. Endoscopic incision to the postoperative cicatrical stenosis of the esophagus.  Gastroenterol Endosc. 1978;  20 359
• 43 Inagake M, Yamane T, Kitao Y, Okozumi J, Kuwata K, Yamaguchi T, Ohya K, Sawai K, Kojima O, Takahashi T. Balloon dilatation for anastomotic stricture after upper gastrointestinal surgery.  World J Surg. 1992;  16 541-544
• 44 Lee M, Kubik C M, Polhamus C D, Brady 3rd  C E, Kadakia S. Preliminary experience with endoscopic intralesional steroid injection therapy for refractory upper gastrointestinal strictures.  Gastrointest Endosc. 1995;  41 598-601
• 45 Iwasaki T, Hayashi N, Kimoto T, Murashima S, Nakashima T, Odori T, Ishii Y, Noriki S, Yoshioka T, Uchida H. Application of a self-expanding metallic stent to a strictured esophagojejunostomy.  Cardiovasc Intervent Radiol. 1993;  16 102-104
• 46 Inagake M, Yamane T, Kitao Y, Okuzumi J, Kuwata K, Yamaguchi T, Oya K, Sawai K, Kojima O, Takahashi T. Ballon dilatation for anastomotic stricture after upper gastro-intestinal surgery.  World J Surg. 1992;  16 541-544
• 47 Drabek J, Keil R, Namesny I. The endoscopic treatment of benign esophageal strictures by ballon dilatation.  Dis Esophagus. 1999;  12 28-29
• 48 Üstündag Y, Koseoglu T, Cetin F, Eroglu A, Soran A, Eskioglu E. Self-expandable metallic stent therapy of esophagojejunal stricture in a stapled anastomosis: a case report and review of the literature.  Dig Surg. 2001;  18 211-213
• 49 Ikeguchi M, Oka S, Gomyo Y, Tsujitani S, Maeta M, Kaibara N. Postoperative morbidity and mortality after gastrectomy for gastric carcinoma.  Hepatogastroenterology. 2001;  48 1517-1520
• 50 Kuhlig J, Popiela T, Koldziejczyk P, Sierzega M, Szczepanik A. on behalf of the Polish Gastric Cancer Study Group . Standard D 2 versus extended D 2 (D 2 +) lymphadenectomy for gastric cancer: an interim safety analysis of a multicenter, randomized, clinical trial.  Am J Surg. 2007;  193 10-15
• 51 Izbicki J R, Gawad K A, Quirrenbach S, Hosch S B, Breid V, Knoefel W T, Küpper H U, Broelsch C E. Ist die Klammernaht in der Visceralchirurgie noch gerechtfertigt?.  Chirurg. 1998;  69 725-734
• 52 Meyer L, Meyer F, Dralle H, Ernst M, Lippert H, Gastinger I. Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma.  Langenbecks Arch Surg. 2005;  390 510-516