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Zentralbl Chir 2009; 134(1): 77-82
DOI: 10.1055/s-0028-1098793
Originalarbeit

© Georg Thieme Verlag Stuttgart ˙ New York

Indikationen und Ergebnisse der palliativen Magenresektion beim fortgeschrittenen Magenkarzinom

Indications and Results of Palliative Gastric Resection in Advanced Gastric CarcinomaY. Dittmar1 , R. Voigt1 , M. Heise1 , A. Rabsch1 , K. Jandt1 , U. Settmacher1
  • 1Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena
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Publication History

Publication Date:
25 February 2009 (online)

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Zusammenfassung

Hintergrund: Das Magenkarzinom wird oft erst im UICC-Stadium 3 b oder 4 diagnostiziert. Eine R0-Resektion ist hier nur im Einzelfall erzielbar. Selbst bei diesen Patienten beträgt die 5-Jahre-Überlebensrate weniger als 5 %. Chirurgische Palliativoperationen sind traditionell der Behandlung therapierefraktärer, vitaler Tumorkomplikationen vorbehalten. Patienten und Methodik: Wir berichten über 21 Patienten, die im Zeitraum 2004 bis 2007 in unserer Klinik wegen eines fortgeschrittenen Magenkarzinoms eine palliative Tumorresektion erhielten, wobei bei zehn dieser Patienten die Zuordnung zur palliativen Therapieintention präoperativ und bei elf Patienten diese anhand des Operationsbefundes erfolgte. Im einzelnen wurden 17 Gastrektomien, drei proximale und eine distale Magenresektion vorgenommen. Ergebnisse: Es konnte gezeigt werden, dass die Patienten eine verbesserte Gesamtüberlebenszeit im Vergleich zu konservativ therapierten Patienten haben. Das perioperative Risiko erwies sich bei Auswahl geeigneter Patienten als vertretbar. Das mediane Überleben betrug 16 Monate für die palliativ resezierten Patienten. 80 % der Patienten waren nach sechs Monaten und rund 60 % der Patienten nach 12 Monaten noch am Leben. Die perioperative Mortalität betrug 0 % bei einer durchschnittlichen stationären Aufenthaltsdauer von 12 Tagen. Alle Patienten konnten bei regelhafter Darmpassage und bedarfsgerechter Analgetikatherapie in die häusliche Umgebung entlassen werden. Schlussfolgerungen: Nach unserer Auffassung bietet die palliative Magenresektion einen deutlichen Überlebensvorteil gegenüber allen anderen palliativen Therapieoptionen. Für die Patienten ergibt sich auch eine Verbesserung der Lebensqualität.

Abstract

Background: Gastric carcinoma is often diagnosed at UICC stage 3 b or 4. R0 resection can be achieved only in very few such cases. Even for these patients the 5-year survival rate is less than 5 %. Surgical palliation is traditionally reserved for the treatment of severe tumour complications not responding to other forms of treatment. Patients and Methods: We report on 21 patients who underwent palliative resection for gastric carcinoma at our institution between 2004 and 2007. Ten of these were assigned to palliative surgical treatment pre-operatively while this choice was made for 11 patients on the grounds of the intra-operative findings. We performed 17 gastrectomies, 3 proximal gastric resections and one distal gastric resection. Results: It has been shown that the patients have an improved overall survival time as compared to patients who received non-surgical treatment. The perioperative risk was reasonable when pa­tients were carefully selected. Median survi­val for resected patients was 16 months. 80 % of pa­tients were alive after 6 months and approxi­mate­ly 60 % of patients were alive after 12 months. The peri­operative mortality was 0 % with a mean hospi­tal stay of 12 days. All patients were discharged home with proper bowel passage and analgesia as individually required. Conclusions: We are convinced that palliative gastric resection provides a pronounced survival benefit over any other palliative treatment options. Patients also have an improved quality of life.

Schlüsselwörter

palliative Gastrektomie - fortgeschrittenes Magenkarzinom - Überleben - Lebensqualität

Key words

palliative gastrectomy - advanced gastric cancer - survival - quality of life

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Prof. Dr. med. U. Settmacher

Klinik für Allgemein-, Viszeral- und Gefäßchirurgie · Universitätsklinikum Jena

Erlanger Allee 101

07740 Jena

Phone: 0 36 41 / 9 32 26 01

Fax: 0 36 41 / 9 32 26 02

Email: utz.settmacher@med.uni-jena.de

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