PDF herunterladen
Zentralbl Chir 2014; 139(1): 37-42
DOI: 10.1055/s-0033-1360339
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Möglichkeiten und Grenzen der minimalinvasiven Chirurgie bei Resektion des Ösophagus und des Magens

Scope and Limitations of Minimally Invasive Resections of the Oesophagus and Stomach
C. Wullstein
Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, HELIOS Klinikum Krefeld, Deutschland
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Februar 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Hintergrund: Minimalinvasive Operationsverfahren erfahren bei der Behandlung von Karzinomen des oberen Gastrointestinaltrakts eine zunehmende Verbreitung, wobei mögliche Vorteile und die onkologische Radikalität weiterhin kontrovers diskutiert werden.
Methode: Im Rahmen einer Literaturübersicht werden die aktuellen Studien zur minimalinvasiven Ösophagusresektion und zur laparoskopischen Magenresektion analysiert.
Ergebnisse: Minimalinvasive Ösophagusresektionen und laparoskopische Magenresektionen beim Karzinom sind sicher und führen zu Vorteilen hinsichtlich eines geringeren Blutverlusts, geringerer Schmerzen, einer kürzeren Krankenhausverweildauer und einer Reduktion der perioperativen Morbidität. Pulmonale Komplikationen nach Ösophagusresektion werden durch den Einsatz minimalinvasiver Operationsverfahren reduziert. Die Operationszeit ist bei minimalinvasiven Operationen länger als bei offenen Eingriffen. Die Letalität unterscheidet sich nicht. Das onkologische Resektionsausmaß ist vergleichbar. Wenige Studien zeigten für die laparoskopische Magenresektion eine gering reduzierte Anzahl an Lymphknoten, das Langzeitüberleben unterscheidet sich nicht von der konventionellen Operation.
Schlussfolgerung: Minimalinvasive Ösophagus- und Magenresektionen sind sicher, zeigen zahlreiche Vorteile in der postoperativen Rekonvaleszenz und führen zu einer reduzierten Morbidität. Bei ihrer Anwendung müssen die onkologischen Standards der konventionellen Operation eingehalten werden.

Abstract

Background: Although minimally invasive surgery is being increasingly performed for the treatment of upper gastrointestinal cancers, the discussion on potential advantages and oncological accuracy is still controversial.
Material and Methods: In the framework of a literature survey, current trials on minimally invasive oesophageal resection and laparoscopic abdominal surgery have been analysed.
Results: Minimally invasive oesophagectomy and laparoscopic gastric resections for cancer are safe. Minimally invasive resections result in an improved short-term outcome postoperatively in view of less pain, less blood loss and shorter duration of hospital stay. While mortality is equal, morbidity following minimally invasive surgery is reduced. Especially pulmonary complications decrease on the application of minimally invasive oesophagectomy. Minimally invasive operations last longer than open procedures. The oncological results seem to be equal between open and minimally invasive operations. A few studies have shown that laparoscopic gastric resections may result in a reduced number of lymph nodes harvested. The long-term survival between open and laparoscopic resections did not differ in any study.
Conclusion: Minimally invasive resections for oesophageal and gastric cancer are safe and show several advantages in short-term outcome. Oncological long-term results seem to be comparable. The potential risk of a reduced number of harvested lymph nodes during laparoscopic gastrectomy has to be addressed by an adequate surgical technique.

Schlüsselwörter

Ösophaguskarzinom - Magenkarzinom - Laparoskopie - minimalinvasive Chirurgie - Ösophagektomie - Gastrektomie

Key words

oesophageal cancer - gastric cancer - laparoscopy - minimally invasive surgery - oesophagectomy - gastrectomy
 

  • Literatur

  • 1 Hulscher JB, van Sandick JW, de Boer AG et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347: 1662-1669
    CrossrefPubMedGoogle Scholar
  • 2 Koppert LB, Lemmens VE, Coebergh JW et al. Impact of age and co-morbidity on surgical resection rate and survival in patients with oesophageal and gastric cancer. Br J Surg 2012; 99: 1693-1700
    CrossrefPubMedGoogle Scholar
  • 3 Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 2007; 8: 545-553
    CrossrefPubMedGoogle Scholar
  • 4 Moehler M. und die Mitglieder der Autorengruppe. S3-Leitlinie „Magenkarzinom“ – Diagnostik und Therapie der Adenokarzinome des Magens und ösophagogastralen Übergangs (AWMF-Regist.-Nr. 032-009-OL). Z Gastroenterol 2011; 49: 461-531
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Birkmeyer JD, Dimick JB, Staiger DO. Operative mortality and procedure volume as predictors of subsequent hospital performance. Ann Surg 2006; 243: 411-417
    CrossrefPubMedGoogle Scholar
  • 6 Mamidanna R, Bottle A, Aylin P et al. Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 2012; 255: 197-203
    CrossrefPubMedGoogle Scholar
  • 7 Schwenk W, Haase O, Neudecker J et al. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2005; (3) CD003145
    PubMedGoogle Scholar
  • 8 Bonjer HJ, Hop WC, Nelson H et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 2007; 142: 298-303
    CrossrefPubMedGoogle Scholar
  • 9 Kuhry E, Schwenk W, Gaupset R et al. Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 2008; 34: 498-504
    CrossrefPubMedGoogle Scholar
  • 10 Cushieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 1992; 37: 7-11
    PubMedGoogle Scholar
  • 11 McAnena OJ, Rogers J, Wiliams NS. Right thoracoscopically assisted oesophagectomy for cancer. Br J Surg 1994; 81: 236-238
    CrossrefPubMedGoogle Scholar
  • 12 Luketich J, Alvelo-Rivera M, Buenaventura P et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 2003; 238: 486-495
    PubMedGoogle Scholar
  • 13 Kitano S, Iso Y, Moriyama M et al. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4: 146-148
    PubMedGoogle Scholar
  • 14 Kitano S, Shiraishi N, Uyama I et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007; 245: 68-72
    CrossrefPubMedGoogle Scholar
  • 15 Decker G, Coosemans W, De Leyn P et al. Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg 2009; 35: 13-21
    CrossrefPubMedGoogle Scholar
  • 16 Luketich JD, Pennathur A, Awais O et al. Outcomes after minimally invasive esophagectomy, review of over 1000 patients. Ann Surg 2012; 256: 95-103
    CrossrefPubMedGoogle Scholar
  • 17 Palanivelu C, Prakash A, Senthilkumar R et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position–experience of 130 patients. J Am Coll Surg 2006; 203: 7-16
    CrossrefPubMedGoogle Scholar
  • 18 Verhage RJJ, Hazebroek EJ, Boone J et al. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature. Minerva Chir 2009; 64: 135-146
    PubMedGoogle Scholar
  • 19 Nagpal K, Ahmed K, Vats A et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 2010; 24: 1621-1629
    CrossrefPubMedGoogle Scholar
  • 20 Biere SS, van Berge Henegouwen MI, Maas KW et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379: 1887-1892
    CrossrefPubMedGoogle Scholar
  • 21 Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg 2012; 16: 486-494
    CrossrefPubMedGoogle Scholar
  • 22 Osugi H, Takemura M, Higashino M et al. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg 2003; 90: 108-113
    CrossrefPubMedGoogle Scholar
  • 23 Smithers BM, Gotley DC, Martin I et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 2007; 245: 232-240
    CrossrefPubMedGoogle Scholar
  • 24 Lazzarino AI, Nagpal K, Bottle A et al. Open versus minimally invasive esophagectomy, trends of utilization and associated outcomes in England. Ann Surg 2010; 252: 292-298
    CrossrefPubMedGoogle Scholar
  • 25 Koeda K, Nishizuka S, Wakabayashi G. Minimally invasive surgery for gastric cancer: the future standard of care. World J Surg 2011; 35: 1469-1477
    CrossrefPubMedGoogle Scholar
  • 26 Kunisaki C, Makino H, Kosaka T et al. Surgical outcomes of laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a case-control study. Surg Endosc 2012; 26: 804-810
    CrossrefPubMedGoogle Scholar
  • 27 Kim YW, Baik YH, Yun YH et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 2008; 248: 721-727
    CrossrefPubMedGoogle Scholar
  • 28 Takiguchi S, Fujiwara Y, Yamasaki M et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg 2013; 37: 2379-2386
    CrossrefPubMedGoogle Scholar
  • 29 Ohtani H, Tamamori Y, Noguchi K et al. Meta-analysis of laparoscopy-assisted and open distal gastrectomy for gastric cancer. J Surg Res 2011; 171: 479-485
    CrossrefPubMedGoogle Scholar
  • 30 Chen K, Xu XW, Mou YP et al. Systematic review and meta-analysis of laparoscopic and open gastrectomy for advanced gastric cancer. World J Surg Oncol 2013; 11: 182
    CrossrefPubMedGoogle Scholar
  • 31 Shinohara T, Satoh S, Kanaya S et al. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 2013; 27: 86-94
    CrossrefPubMedGoogle Scholar
  • 32 Jeong O, Jung MR, Kim GY et al. Comparison of short-term surgical outcomes between laparoscopic and open total gastrectomy for gastric carcinoma: case-control study using propensity score matching method. J Am Coll Surg 2013; 216: 184-191
    CrossrefPubMedGoogle Scholar
  • 33 Yakoub D, Athanasiou T, Tekkis P et al. Laparoscopic assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach?. Surg Oncol 2009; 18: 322-333
    CrossrefPubMedGoogle Scholar
  • 34 Zeng YK, Yang ZL, Peng JS et al. Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer – evidence from randomized and nonrandomized clinical trials. Ann Surg 2012; 256: 39-52
    CrossrefPubMedGoogle Scholar
  • 35 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: 232-237
    CrossrefPubMedGoogle Scholar
  • 36 Park DJ, Han SU, Hyung WJ et al. Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 2012; 26: 1548-1553
    CrossrefPubMedGoogle Scholar
  • 37 Guo W, Zou YB, Ma Z et al. One surgeonʼs learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence?. Surg Endosc 2013; 27: 1346-1352
    CrossrefPubMedGoogle Scholar
  • 38 Osugi H, Takemura M, Higashino M et al. Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 2003; 17: 515-519
    CrossrefPubMedGoogle Scholar
  • 39 Ramage L, Deguara J, Davies A et al. Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue. Ann R Coll Surg Engl 2013; 95: 329-334
    PubMedGoogle Scholar
  • 40 Kim HG, Park JH, Jeong SH et al. Totally laparoscopic distal gastrectomy after learning curve completion: comparison with laparoscopy-assisted distal gastrectomy. J Gastric Cancer 2013; 13: 26-33
    CrossrefPubMedGoogle Scholar
  • 41 Atkins BZ, Shah AS, Hutcheson KA et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78: 1170-1176
    CrossrefPubMedGoogle Scholar
  • 42 Takeuchi H, Saikawa Y, Oyama T et al. Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. World J Surg 2010; 34: 277-284
    CrossrefPubMedGoogle Scholar
  • 43 Kinugasa S, Tachibana M, Yoshimura H et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol 2004; 88: 71-77
    CrossrefPubMedGoogle Scholar
  • 44 Derogar M, Orsini M, Sadr-Azodi O et al. Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery. J Clin Oncol 2012; 30: 1615-1619
    CrossrefPubMedGoogle Scholar
  • 45 Markar SR, Karthikesalingam A, Thrumuthy S et al. Systematic review and pooled analysis assessing the association between elderly age and outcome following surgical resection of esophageal malignancy. Dis Esophagus 2013; 26: 250-262
    CrossrefPubMedGoogle Scholar
  • 46 Amato A, Pscatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 2006; (1) CD005033
    PubMedGoogle Scholar
  • 47 Liang YX, Guo HH, Deng JY et al. Impact of intraoperative blood loss on survival after curative resection for gastric cancer. World J Gastroenterol 2013; 19: 5542-5550
    CrossrefPubMedGoogle Scholar
  • 48 Langley SM, Alexiou C, Bailey DH et al. The influence of perioperative blood transfusion on survival after esophageal resection for carcinoma. Ann Thorac Surg 2002; 73: 1704-1709
    CrossrefPubMedGoogle Scholar
  • 49 Komatsu Y, Orita H, Sakurada M et al. Intraoperative blood transfusion contributes to decreased long-term survival of patients with esophageal cancer. World J Surg 2012; 36: 844-850
    CrossrefPubMedGoogle Scholar