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Zentralbl Chir 2001; 126(10): 756-762
DOI: 10.1055/s-2001-18253
Originalarbeiten und Übersichten

J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG

Wie radikal soll das Ösophagus- bzw. Kardiakarzinom operiert werden?[*]

What Kind of Surgical Radicality is Justified in the Treatment of Esophageal and Esophago-gastric Junction Tumours?A. Vörös1 , Á. Altorjay1 , P. Nagy2 , T. Jakkel1 , Á. Bohák3 , I. Szántó1 , E. M. Gamal1 , J. Kiss1
  • 1Department of Surgery, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
  • 2Department of Pathology, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
  • 3Department of Radiology, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
Further Information

Publication History

Publication Date:
06 November 2001 (online)

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Summary

In the period from January 1, 1973 to November 30, 1994, a total number of 1 856 patients had been admitted to our Department of Surgery because of cancer of the esophagus and esophago-gastric junction. We divided our activities into two study periods. In the first study period from 1973 to 1984 only so called “conventional operations” were performed. Since 1985 new oncological aspects were introduced into our operative tactics:
1. the subtotal esophagectomy combined with the two-field lymphadenectomy,
2. the total gastrectomy with extended lymph node dissection.
The analysis of our results with respect to the survival parameters (TNM staging, histological type, grade of differentiation, gross pathology) showed that the best chances were obtained by curative resection and lymphadenectomy in tumours of low-grade biologic malignancy. In esophageal cancers the former 6 % 5-year cumulative survival rate increased to 26 %, and in cardia tumours from 9 to 27 %, because of enhancement of radicality and extension of lymphadenectomy.

Zusammenfassung

Zwischen dem 1. Januar 1973 und 30. November 1994 wurden insgesamt 1 856 Patienten wegen eines Ösophagus- bzw. Kardiakarzinoms in unsere chirurgische Abteilung eingewiesen. Wir untersuchten zwei Beobachtungsperioden: in der ersten Zeit (1973-1984) wurden sogenannte „konventionelle Operationen” durchgeführt, seit 1985 haben wir neue onkologische Aspekte bei der operativen Therapie berücksichtigt:
1. Seit dieser Zeit wurde die subtotale Ösophagektomie mit einer Zweifelderlymphadenektomie kombiniert und
2. wurde bei der Gastrektomie eine ausgedehnte Lymphknotendissektion vorgenommen.
Wir überprüften das Überleben unserer Patienten hinsichtlich der Parameter TNM-Stadium, histologischer Typ, Tumordifferenzierungsgrad und makroskopischer Befund. Es zeigte sich, daß die besten Überlebenschancen bei kurativer Resektion und gleichzeitiger Lymphadenektomie von Tumoren mit niedrigem Malignitätsgrad gegeben waren.
Beim Ösophaguskarzinom stieg die kumulative 5-Jahres-Überlebensrate von 6 auf 26 %, beim Kardiakarzinom von 9 auf 27 % an. Dies beruhte auf einer Zunahme der Radikalität und Ausweitung der Lymphadenektomie.

Key words

Esophagus - Cardia - Tumours - Resection - Lymphadenectomy - Survival rates

Schlüsselwörter

Ösophaguskarzinom - Kardiakarzinom - Resektion - Lymphadenektomie - Überlebensraten

1 Übersetzung: R.T. Grundmann, Melsungen

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1 Übersetzung: R.T. Grundmann, Melsungen

Dr. A. Vöro`s ·Postgraduate Medical University 

Department of Surgery

Szabolcs u. 35

Pf. 1 12


1389 Budapest

Hungary