fr
Article scientifique
Revue de la littérature
Allemand

Chirurgische Strategie bei Frühkarzinomen des Ösophagus

Autre titre[Surgical strategy for early stage carcinoma of the esophagus]
Publié dansDer Chirurg, vol. 89, no. 5, p. 339-346
Date de publication2018-05
Résumé

Early stage carcinomas of the esophagus are histologically differentiated into adenocarcinomas and squamous cell carcinomas and subdivided into mucosal (m1-3) and submucosal (sm1-3) carcinomas depending on the infiltration depth. While the prevalence of lymph node metastases in mucosal carcinomas is very low, the probability of lymph node metastases increases from submucosal infiltration with increasing depth. According to the current German S3 guidelines endoscopic resection is the recommended treatment strategy for mucosal adenocarcinoma without histological risk factors (lymphatic invasion [L1], venous invasion [V1], poorly differentiated [>G2], microscopic residual disease [R1] at the deep resection margin). For superficial submucosal infiltration (sm1) without histological risk factors endoscopic resection can also be carried out, whereby in this case the guidelines make a stronger recommendation for esophagectomy. For squamous cell carcinoma endoscopic resection is indicated for an infiltration depth up to middle layer mucosal carcinoma (m2) without histological risk factors. Outside of these criteria an esophageal resection should always be carried out. The surgical gold standard is a subtotal abdominothoracic esophagectomy with two-field lymphadenectomy. Alternative procedures are total esophagectomy in proximal esophageal carcinoma and transhiatal extended gastrectomy for carcinoma of the cardia. Limited proximal or distal esophageal resections can be performed in proximal or distal mucosal carcinoma without the possibility of endoscopic resection; however, partial resections are not superior in terms of functional results and are not oncologically equivalent due to limited lymphadenectomy. Minimally invasive procedures show good oncological results and reduce the morbidity of radical esophagectomy. Reduced morbidity might be an argument for surgical resection in borderline cases between endoscopic and surgical resection.

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Mots-clés
  • Ivor Lewis resection
  • Lymph node metastases
  • Lymphadenectomy
  • Minimally invasive esophagectomy
  • Submucosal infiltration
  • Adenocarcinoma / surgery
  • Carcinoma, Squamous Cell / surgery
  • Esophageal Neoplasms / surgery
  • Esophagectomy
  • Humans
  • Lymphatic Metastasis
  • Neoplasm Staging
Citation (format ISO)
NICLAUSS, Nadja et al. Chirurgische Strategie bei Frühkarzinomen des Ösophagus. In: Der Chirurg, 2018, vol. 89, n° 5, p. 339–346. doi: 10.1007/s00104-018-0589-2
Fichiers principaux (1)
Article (Published version)
accessLevelRestricted
Identifiants
ISSN du journal0009-4722
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Création31.01.2022 15:51:00
Première validation31.01.2022 15:51:00
Heure de mise à jour16.03.2023 02:33:24
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