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Zentralbl Chir 2001; 126(9): 676-681
DOI: 10.1055/s-2001-18235
Endokrine Chirurgie

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

Chirurgische Therapie bei Karzinoiden des Gastrointestinaltraktes

Surgical therapy of gastrointestinal carcinoid tumorsTh. Böttger
  • Klinik und Poliklinik für Allgemein- und Abdominalchirurgie (Direktor: Prof. Dr. Th. Junginger), Johannes Gutenberg-Universität Mainz
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Publication Date:
06 November 2001 (online)

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Surgical therapy of gastrointestinal carcinoid tumors

Summary

More than 70 % of all carcinoids are localized in the gastrointestinal tract. Carcinoids of the upper, middle and lower intestines have to be distinguished ontogenetically. The classification according to Capella takes into account the size of the tumor (< 0.9 cm; 1-2 cm; > 2 cm), the grade of invasion of other structures, the grade of angioinvasion, the biologic behaviour, the grade of differentiation and the hormonal activity of the tumor. A carcinoid-syndrome is rarely found. Carcinoids of the small intestine occur multiple in 30-50 % and in 20-30 % a second malignant tumor is seen. In carcinoids of the colon this percentage is even higher (25-40 %). The therapy of carcinoids depends on the size of the tumor and consecutively on the risk of metastasis. A local excision or non-oncologic radical operative procedure is justified in carcinoids smaller than 1 cm. In tumors 1-2 cm in size an individual decision has to be made. Larger tumors should be operated according to oncologic standards. Palliative resections, even of the liver, may be indicated to relieve the symptoms of a carcinoid-syndrome or, to prevent ileus or bleeding in the gastrointestinal tract. The prognosis of gastrointestinal carcinoids is heterogenous: The five-year-survival-rate of appendix-carcinoids is 85.9 % over all stages. In rectal carcinoids this rate amounts to 72.2 %, in carcinoids of the small intestines to 55.4 % and in colon-carcinoids to 41.6 %. Carcinoids of the stomach have a five-year-survival-rate of 64.3 % in the absence of metastases. Within carcinoids of the stomach type III-tumors have the worst prognosis with a median survival time of 6.5 months.

Zusammenfassung

Karzinoide sind in über 70 % im Gastrointestinaltrakt lokalisiert. Entwicklungsgeschichtlich werden solche des Vorder-, Mittel- und Enddarmes unterschieden. Die Klassifikation erfolgt nach Capella und berücksichtigt die Tumorgröße (< 0,9 cm, 1-2 cm, > 2 cm), die Ausbreitung in Nachbarstrukturen, eine Angioinvasion, das biologische Verhalten, den Differenzierungsgrad und die hormonelle Aktivität des Tumors. Ein Karzinoid-Syndrom wird selten beobachtet. Dünndarmkarzinoide sind in 30-50 % multipel, Zweitmalignome werden in 20-30 % und bei Karzinoiden des Kolons synchrone Karzinome sogar in 25-40 % beobachtet. Die Therapie der Karzinoide richtet sich vor allem nach der Größe des Tumors und dem damit verbundenen Metastasierungsrisiko. Im Allgemeinen ist eine lokale Abtragung bzw. ein eingeschränkt radikales operatives Vorgehen bei kleiner als 1 cm großen Tumoren gerechtfertigt. Bei 1-2 cm ist das therapeutische Vorgehen individuell abzuwägen. Größere Tumoren sollten nach onkologischen Gesichtspunkten operiert werden. Palliative Resektionen können, auch an der Leber, zur Besserung eines Karzinoid-Syndroms oder im Gastrointestinaltrakt zur Vermeidung eines Ileus bzw. einer Blutung indiziert sein. Die Prognose gastrointestinaler Karzinoide ist heterogen. Über alle Stadien liegt die 5-Jahresüberlebensrate bei Karzinoiden der Appendix bei 85,9 %, des Rektums bei 72,2 %, des Dünndarmes bei 55,4 % und des Kolons bei 41,6 %. Karzinoide des Magens haben beim Fehlen von Metastasen eine 5-Jahresüberlebensrate von 64,3 %, wobei der Typ III die ungünstigste Prognose mit einer medianen Überlebenszeit von 6,5 Monaten aufweist.

Key words

Carcinoid tumors - gastrointestinal tract - surgical therapy

Schlüsselwörter

Gastrointestinale Karzinoide - chirurgische Therapie

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Prof. Dr. Th. Böttger

Klinik und Poliklinik für Allgemein- und Abdominalchirurgie
Johannes Gutenberg-Universität Mainz

Langenbeckstraße 1

D-55101 Mainz

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