Adenokarzinome des ösophagogastralen Überganges: Double-Tract-Rekonstruktion – Evidenz und Technik

Zusammenfassung

Adenokarzinome des ösophagogastralen Überganges (AEG) stellen nach wie vor eine chirurgisch herausfordernde Tumorentität dar. Entgegen dem Trend der thorakoabdominellen Resektion bei AEG-I- und AEG-II-Tumoren hat sich in den letzten Jahren die proximale Gastrektomie durch moderne Rekonstruktionsverfahren wie die Double-Tract-Rekonstruktion einen Stellenwert in der Chirurgie von AEG-Tumoren und proximalen Magenkarzinomen zurückerobert. Die proximale Gastrektomie mit Double-Tract-Rekonstruktion stellt so bei geeigneten AEG-II-Tumoren eine Alternative zur thorakoabdominellen Ösophagusresektion mit Rekonstruktion durch Magenhochzug dar sowie bei AEG-III-Tumoren eine Alternative zur totalen Gastrektomie. Im Vergleich zur totalen Gastrektomie zeigen vergleichende Studien einen funktionellen Vorteil für die Rekonstruktion mittels Double Tract nach proximaler Gastrektomie. Die präzise onkologische Indikationsstellung hinsichtlich des Resektionsausmaßes muss hingegen für lokal fortgeschrittene Tumoren noch weiter untersucht werden, ebenso der Einfluss der Restmagengröße auf das funktionelle Outcome, da sich hier die asiatischen Techniken für Frühkarzinome deutlich von den europäischen unterscheiden können. Im Folgenden soll die bestehende Evidenz der proximalen Gastrektomie mit Double-Tract-Rekonstruktion dargelegt und technische Aspekte der Rekonstruktionsmethode im Kontext von Tumoren des ösophagogastralen Überganges beleuchtet werden.

Abstract

Adenocarcinoma of the esophagogastric junction (AEG) still represent a certain surgical challenge. In contrary to the trend of thoracoabdominal surgery for AEG I and AEG II cancer, the proximal gastrectomy is regaining popularity through new reconstruction methods such as the double tract reconstruction. Proximal gastrectomy followed by double tract reconstruction represents an alternative for the thoracoabdominal approach for suitable AEG II cancer and an alternative to the total gastrectomy for AEG III cancers. Latest studies suggest a functional benefit of proximal gastrectomy and double tract reconstruction in comparison to total gastrectomy. The accurate indication for proximal gastrectomy for locally advanced cancers has to be established in the near future as well as the influence of the size of the remnant stomach on the outcome, as Asian techniques for early lesions sometimes significantly differ from European. The following article reflects the present evidence on proximal gastrectomy and double tract reconstruction as well as technical aspects in the context of cancer of the esophagogastric junction.

Schlüsselwörter

Double-Tract-Rekonstruktion - proximale Gastrektomie - AEG-Tumore - Gastrektomie - Ösophagektomie

Keywords

double tract reconstruction - proximal gastrectomy - AEG - gastrectomy - esophagectomy

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