Behandlung des Magenkarzinoms – Stadienadaptierte chirurgische Therapie und minimal-invasive Operationsverfahren

Das Magenkarzinom stellt eine der häufigsten Tumorentitäten in Deutschland und weltweit dar. Die Therapie in kurativer Intention ist stadienadaptiert und basiert auf der kompletten Entfernung des Primärtumors sowie in den meisten Tumorstadien einer radikalen D2-Lymphadenektomie. Bei fortgeschrittenen Tumorstadien wird zusätzlich eine perioperative Chemotherapie empfohlen, da sie das Gesamtüberleben verlängert. Dieser Beitrag gibt einen Überblick über die für das jeweilige Tumorstadium empfohlene Therapie sowie die aktuelle Evidenz zu laparoskopischen und robotischen Therapieverfahren.

Publication History

Article published online:
02 March 2022

• Literatur

• 1 Hermann S, Jansen L, Barnes B. et al. Epidemiologie des Magenkarzinoms in Deutschland. Der Onkologe 2020; 26 (10) 887-897
• 2 Kitano S, Iso Y, Moriyama M. et al. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4 (02) 146-148
• 3 Mönig S, Ott K, Gockel I. et al. S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs. Der Chirurg 2020; 91 (01) 37-40
• 4 Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. UICC; 2017
• 5 Probst A, Pagitz M, Messmann H. et al. Endoskopische Resektionsverfahren EMR und ESD – Schritt für Schritt. Gastroenterologie up2date 2018; 14 (04) 309-319
• 6 Tao M, Zhou X, Hu M. et al. Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis. BMJ Open 2019; 9 (12) e025803
• 7 Ronellenfitsch U, Lippert C, Grobholz R. et al. Histology-based prediction of lymph node metastases in early gastric cancer as decision guidance for endoscopic resection. Oncotarget 2016; 7 (09) 10676-10683
• 8 Coburn N, Cosby R, Klein L. et al. Staging and surgical approaches in gastric cancer: A systematic review. Cancer Treat Rev 2018; 63: 104-115
• 9 Ronellenfitsch U, Schwarzbach M, Hofheinz R. et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer 2013; 49 (15) 3149-3158
• 10 Raziee HR, Cardoso R, Seevaratnam R. et al. Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival. Gastric Cancer 2012; 15 (Suppl. 01) S116-S124
• 11 Spicer J, Benay C, Lee L. et al. Diagnostic accuracy and utility of intraoperative microscopic margin analysis of gastric and esophageal adenocarcinoma. Ann Surg Oncol 2014; 21 (08) 2580-2586
• 12 Songun I, Putter H, Kranenbarg EM. et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11 (05) 439-449
• 13 Seevaratnam R, Bocicariu A, Cardoso R. et al. How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer 2012; 15 (Suppl. 01) S70-S88
• 14 Kunisaki C, Sato S, Tsuchiya N. et al. Systemic Review and Meta-analysis of Impact of Splenectomy for Advanced Gastric Cancer. In Vivo 2020; 34 (06) 3115-3125
• 15 Marano L, Rondelli F, Bartoli A. et al. Oncologic Effectiveness and Safety of Splenectomy in Total Gastrectomy for Proximal Gastric Carcinoma: Meta-analysis of Randomized Controlled Trials. Anticancer Res 2018; 38 (06) 3609-3617
• 16 Yamamoto M, Baba H, Kakeji Y. et al. Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer. Hepatogastroenterology 2004; 51 (55) 298-302
• 17 Aversa JG, Diggs LP, Hagerty BL. et al. Multivisceral Resection for Locally Advanced Gastric Cancer. J Gastrointest Surg 2021; 25 (03) 609-622
• 18 Pacelli F, Cusumano G, Rosa F. et al. Multivisceral resection for locally advanced gastric cancer: an Italian multicenter observational study. JAMA Surg 2013; 148 (04) 353-360
• 19 Kosuga T, Tsujiura M, Nakashima S. et al. Current status of function-preserving gastrectomy for gastric cancer. Ann Gastroenterol Surg 2021; 5 (03) 278-286
• 20 Ronellenfitsch U, Najmeh S, Andalib A. et al. Functional outcomes and quality of life after proximal gastrectomy with esophagogastrostomy using a narrow gastric conduit. Ann Surg Oncol 2015; 22 (03) 772-779
• 21 Nunobe S, Ida S. Current status of proximal gastrectomy for gastric and esophagogastric junctional cancer: A review. Ann Gastroenterol Surg 2020; 4 (05) 498-504
• 22 Aurello P, Magistri P, Nigri G. et al. Surgical management of microscopic positive resection margin after gastrectomy for gastric cancer: a systematic review of gastric R1 management. Anticancer Res 2014; 34 (11) 6283-6288
• 23 Bissolati M, Desio M, Rosa F. et al. Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study. Gastric Cancer 2017; 20 (01) 70-82
• 24 Henning GT, Schild SE, Stafford SL. et al. Results of irradiation or chemoirradiation for primary unresectable, locally recurrent, or grossly incomplete resection of gastric adenocarcinoma. Int J Radiat Oncol Biol Phys 2000; 46 (01) 109-118
• 25 Stiekema J, Trip AK, Jansen EP. et al. The prognostic significance of an R1 resection in gastric cancer patients treated with adjuvant chemoradiotherapy. Ann Surg Oncol 2014; 21 (04) 1107-1114
• 26 Weber MC, Berlet M, Novotny A. et al. Reconstruction following gastrectomy. Chirurg 2021; 92 (06) 506-514
• 27 Syn NL, Wee I, Shabbir A. et al. Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies. Ann Surg 2019; 269 (06) 1041-1053
• 28 Gertsen EC, Brenkman HJF, Haverkamp L. et al. Worldwide Practice in Gastric Cancer Surgery: A 6-Year Update. Dig Surg 2021; 38 (04) 266-274
• 29 Caruso S, Patriti A, Roviello F. et al. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations. World J Gastroenterol 2016; 22 (25) 5694-5717
• 30 Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surg Clin North Am 2003; 83 (06) 1429-1444
• 31 Kakeji Y, Konishi K, Ieiri S. et al. Robotic laparoscopic distal gastrectomy: a comparison of the da Vinci and Zeus systems. Int J Med Robot 2006; 2 (04) 299-304
• 32 Tsai SH, Liu CA, Huang KH. et al. Advances in Laparoscopic and Robotic Gastrectomy for Gastric Cancer. Pathol Oncol Res 2017; 23 (01) 13-17
• 33 Huscher CG, 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 (02) 232-237
• 34 Kim HH, Han SU, Kim MC. et al. Effect of Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy on Long-term Survival Among Patients With Stage I Gastric Cancer: The KLASS-01 Randomized Clinical Trial. JAMA Oncol 2019; 5 (04) 506-513
• 35 Hyung WJ, Yang HK, Park YK. et al. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol 2020; 38 (28) 3304-3313
• 36 Katai H, Mizusawa J, Katayama H. et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 2020; 5 (02) 142-151
• 37 Yu J, Huang C, Sun Y. et al. Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer: The CLASS-01 Randomized Clinical Trial. Jama 2019; 321 (20) 1983-1992
• 38 Liu F, Huang C, Xu Z. et al. Morbidity and Mortality of Laparoscopic vs Open Total Gastrectomy for Clinical Stage I Gastric Cancer: The CLASS02 Multicenter Randomized Clinical Trial. JAMA Oncol 2020; 6 (10) 1590-1597
• 39 van der Veen A, Brenkman HJF, Seesing MFJ. et al. Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA): A Multicenter Randomized Clinical Trial. J Clin Oncol 2021; 39 (09) 978-989
• 40 Liao G, Wang Z, Li H. et al. Learning curve and short-term outcomes of modularized LADG for advanced gastric cancer: A retrospective study. Medicine (Baltimore) 2019; 98 (10) e14670
• 41 NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer – Version 5.2021. 2021
• 42 Pan HF, Wang G, Liu J. et al. Robotic Versus Laparoscopic Gastrectomy for Locally Advanced Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2017; 27 (06) 428-433
• 43 Lu J, Zheng CH, Xu BB. et al. Assessment of Robotic Versus Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Controlled Trial. Ann Surg 2021; 273 (05) 858-867
• 44 Li ZY, Zhao YL, Qian F. et al. Long-term oncologic outcomes of robotic versus laparoscopic gastrectomy for locally advanced gastric cancer: a propensity score-matched analysis of 1170 patients. Surg Endosc 2021;
• 45 Shin HJ, Son SY, Wang B. et al. Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients. Ann Surg 2021; 274 (01) 128-137
• 46 Kim MS, Kim WJ, Hyung WJ. et al. Comprehensive Learning Curve of Robotic Surgery: Discovery From a Multicenter Prospective Trial of Robotic Gastrectomy. Ann Surg 2021; 273 (05) 949-956