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Magenstumpfkarzinom: Häufigkeit, Therapie, Komplikationen und Prognose

Gastric stump carcinoma: frequency, treatment, complications and prognosis

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Zusammenfassung

Hintergrund

Magenstumpfkarzinome entstehen im Restmagen nach partieller Gastrektomie. Während die Häufigkeit des Magenkarzinoms abnimmt, bleibt die Inzidenz des Magenstumpfkarzinoms aufgrund einer langen Latenzzeit stabil. Nachdem die chirurgische Therapie von Magenulzera durch partielle Gastrektomien an Bedeutung verloren hat, entwickeln sich zunehmend Magenstumpfkarzinome nach onkologischen Resektionen.

Zielsetzung

Ziel dieser Arbeit war es, die chirurgische Therapie von Magenstumpfkarzinomen mit der von Magenkarzinomen zu vergleichen.

Material und Methoden

Von 2001 bis 2014 wurden 24 Patienten mit Magenstumpfkarzinomen an der Universitätsklinik Heidelberg operiert. Im gleichen Zeitraum wurden 428 Patienten aufgrund eines primären Magenkarzinoms operiert. Die beiden Gruppen wurden mit Bezug auf die präoperative Therapie, intraoperative Unterschiede, Komplikationen und das Gesamtüberleben verglichen.

Ergebnisse

Es zeigte sich ein höheres Erkrankungsalter bei Patienten mit Magenstumpfkarzinomen (68 vs. 62 Jahre, p = 0,03). Im Vergleich zum primären Magenkarzinom wurde häufiger der Verdacht auf einen Lymphknotenbefall (cN+) geäußert (51,4 vs. 41,7 %, p < 0,001). Eine neoadjuvante Therapie erfolgte seltener (14,3 vs. 48,7 %, p < 0,01). Bei der Resektion von Magenstumpfkarzinomen waren häufiger Eingriffserweiterungen erforderlich (54,5 vs. 28,2 %, p < 0,001). Es zeigte sich kein signifikanter Unterschied im medianen Überleben zwischen den beiden Patientengruppen (64,4 vs. 45,8 Monate, p = 0,34).

Schlussfolgerung

Trotz der beschriebenen Unterschiede unterscheidet sich die Therapie von Magenstumpfkarzinomen nicht wesentlich von der des primären Magenkarzinoms. Magenstumpfkarzinome sind deutlich häufiger lokal fortgeschritten. Eine neoadjuvante Therapie sollte unserer Meinung nach analog zum Magenkarzinom durchgeführt werden, auch wenn die Datenlage hierfür begrenzt ist.

Abstract

Background

Gastric stump carcinoma develops in the gastric remnant after partial gastrectomy. While the frequency of gastric cancer is declining, the incidence of gastric stump carcinoma has remained stable due to the long latency period. As the surgical treatment of gastric ulcers by partial gastrectomy has become much less important, more and more gastric stump carcinomas develop after oncological resection.

Aim

This study compared the surgical therapy of gastric stump carcinoma with the therapy of primary gastric cancer.

Material and methods

From 2001 to 2014 a total of 24 patients were surgically treated for gastric stump carcinoma in the University Hospital of Heidelberg. In the same time 428 patients underwent resection due to primary gastric cancer. Both groups were analyzed and compared with a focus on preoperative therapy, intraoperative differences, complications and overall survival.

Results

Patients with gastric stump carcinoma were older at disease onset (68 years vs. 62 years, p = 0.003). Compared with primary gastric cancer, patients with gastric stump carcinoma were more often suspected of having lymph node (cN+) involvement (51.4 % vs. 41.7 %, p < 0.001) but neoadjuvant therapy was applied less often (48.7 % vs. 14.3 %, p < 0.01). For resection of gastric stump carcinoma, extended resections were more often necessary (54.5 % vs. 28.2 %, p < 0.001). There were no significant differences in mean overall survival between the two patient groups (64.4 months vs. 45.8 months, p = 0.34)

Conclusion

Despite the differences described, the treatment of gastric stump carcinoma does not essentially differ from that of primary gastric cancer. Carcinomas of the gastric stump are more often locally advanced and in our opinion a neoadjuvant therapy should be applied analogue to gastric cancer even if evidence-based data on this point are limited.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland

    H. Nienhüser, S. Blank, L. Sisic, R. Kunzmann, U. Heger, M. W. Büchler, T. Schmidt &  A. Ulrich

  2. Abteilung für Allgemein-, Vaskulär und Thoraxchirurgie, RoMed Klinikum Rosenheim, 83022, Rosenheim, Deutschland

    K. Ott

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  1. H. Nienhüser
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Correspondence to A. Ulrich.

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Interessenkonflikt

H. Nienhüser, S. Blank, L. Sisic, R. Kunzmann, U. Heger, K. Ott, M.W. Büchler, T. Schmidt und A. Ulrich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Die Autoren T. Schmidt und A. Ulrich haben zu gleichen Teilen zu der Arbeit beigetragen.

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Nienhüser, H., Blank, S., Sisic, L. et al. Magenstumpfkarzinom: Häufigkeit, Therapie, Komplikationen und Prognose. Chirurg 88, 317–327 (2017). https://doi.org/10.1007/s00104-016-0296-9

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