R1-Resektion in der Chirurgie des oberen Gastrointestinaltrakts

Lordick, Florian; K, Ott; Novotny, Alexander; Schuhmacher, Christoph; Siewert, J. R.

doi:10.1007/s00104-007-1381-x

Cited by 13 publications

(3 citation statements)

References 36 publications

(22 reference statements)

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“…Although esophageal cancer shows 5-year-survival rates of only 10-20% there are mainly two factors that apparently increase survival to a great extent; Wrstly, the completeness of response that can lead up to 40% increased survival rates in some centers (Holscher and Vallbohmer 2007;Lordick et al 2007) and secondly an increase up to 60% if complete histopathologic response was achieved after applied multimodality treatment (Heitmiller 2001;Schneider et al 2005a;Wong and Malthaner 2000). Although controversially discussed since almost a decade, neoadjuvant treatment is now widely used in the therapy of esophageal cancer (Mathew and Jamieson 1997;Swisher et al 1996;Urba et al 2001).…”

Section: Introductionmentioning

confidence: 99%

Methylated DAPK and APC promoter DNA detection in peripheral blood is significantly associated with apparent residual tumor and outcome

Hoffmann

Vallböhmer

Prenzel

et al. 2009

J Cancer Res Clin Oncol

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Preoperative measurement of methylated DAPK and APC promoter DNA in peripheral blood may contribute to better estimate postoperative survival chances of patients with esophageal carcinoma, especially adenocarcinoma. The postoperative detection of methylated APC in peripheral blood might provide crucial information on apparent residual tumor and might be used as a "molecular" R0-Marker in addition to the pathologic examination.

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Section: Introductionmentioning

confidence: 99%

Methylated DAPK and APC promoter DNA detection in peripheral blood is significantly associated with apparent residual tumor and outcome

Hoffmann

Vallböhmer

Prenzel

et al. 2009

J Cancer Res Clin Oncol

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“…The question how to treat patients best with residual tumor (R1 resection) cannot clearly be answered based on the literature [77]. The decision on an additive chemoradiotherapy is based on the localization of the residual tumor, the postoperative performance status of the patient, and his risk factors for systemic and local tumor progression.…”

Section: Incomplete (R1) Resectionsmentioning

confidence: 99%

Gastric cancer: surgery in 2011

Ott

Lordick

Blank

et al. 2011

Langenbecks Arch Surg

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In many East Asian Centers and some other centers in the world, these tumors are resected by a laparoscopic approach. With a high experience, this can be done with excellent quality and outcome. In locally advanced gastric cancer, multimodal treatment can improve survival in comparison to surgery alone. However, the strategies differ significantly around the world. While adjuvant chemoradiotherapy is standard in the USA, in Europe, perioperative chemotherapy is the first choice, and in Japan, adjuvant chemotherapy is recommended. In Europe, three randomized phase III studies on the value of preoperative chemotherapy have been performed. Two of them have shown that perioperative chemotherapy does significantly improve the survival of patients with adenocarcinoma of the stomach and of the esophagogastric junction. The one including only preoperative chemotherapy failed to show a survival benefit for the combined treatment arm but showed excellent outcomes in both the surgery alone and the preoperative chemotherapy arms. Based on these studies, patients with stage II or stage III disease are now treated with perioperative chemotherapy. Additionally, it is generally accepted for more than 10 years now that responding patients have a significantly improved prognosis compared to nonresponding patients. The percentage of responding patients varies depending on the applied regimen between 20% and 45%. Therefore, early response evaluation or response prediction is an utmost important field of research. Proximal tumors are treated with a transhiatal extended gastrectomy, tumors in the middle third with a total gastrectomy, and distal tumors with a subtotal gastrectomy, if possible. Modified D2 lymphadenectomy avoiding splenectomy is now accepted as the standard procedure, providing improved prognosis for certain subgroups of patients. Individualized resection and lymphadenectomy techniques for early tumor stages and response-based neoadjuvant concepts for locally advanced tumors are the challenge for the future.

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“…Lokal fortgeschrittene Magenkarzinome (T3/4-Kategorie) können nach den Daten der deutschen Magenkarzinomstudie nur in 40-60 % der Fälle residualtumorfrei (R0) reseziert werden (13). Welche Vorgehensweise nach einer R1-oder R2-Resektion jedoch die beste ist, ist in Ermangelung systematisch erhobener Daten derzeit nicht klar zu beantworten (7). Im klinischen Alltag machen wir die Entscheidung zur additiven Radiochemotherapie deshalb vom postoperativen Allgemein-und Ernährungszustand des Patienten, von der Lokalisation des Residualtumors und weiterer begleitender Risikofaktoren für eine systemische und lokale Tumorprogression abhängig.…”

Section: Additive Therapie Nach R1/2-resektionunclassified

Chirurgie des Magenkarzinoms: Standards und Innovationen – Von der primären Chirurgie zu multimodalen, individualisierten Strategien

Ott¹,

Lordick²,

Weitz³

et al. 2008

Klinikarzt

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Von der primären Chirurgie zu multimodalen, individualisierten StrategienMagenkarzinome, die initial als cT1/2 kategorisiert werden, bleiben die Domäne der primären Chirurgie, wobei bei T1m/sm-Tumoren mit intestinaler Differenzierung nach Laurén die endoskopische Mukosektomie immer mehr an Bedeutung gewinnt. Bei proximalen Magenkarzinomen früher Tumorstadien (AEG 1 II oder III) kann eine limitierte Kardiaresektion bzw. eine transhiatal erweiterte Gastrektomie, bei distalen Karzinomen eine subtotale Gastrektomie erfolgen. Tumoren an den übrigen Lokalisationen werden durch eine totale Gastrektomie reseziert. Sind die Karzinome bereits lokal fortgeschritten, kann der Einsatz multimodaler Behandlungsstrategien die Prognose der Betroffenen im Vergleich zur alleinigen chirurgischen Therapie günstig beeinflussen. So kann eine perioperative Chemotherapie in diesen Fällen das Gesamtüberleben signifikant verlängern. Patienten mit lokal fortgeschrittenen Magenkarzinomen sollten daher immer in einem Zentrum vorgestellt werden, in dem Therapieempfehlungen interdisziplinär und auf der Grundlage der aktuellen Datenlage getroffen werden. Bei Patienten mit Magenkarzinom sollte immer eine D2-Lymphadenektomie erfolgen, da Subgruppen davon profitieren. Die Individualisierung der Therapie ist die Herausforderung der Zukunft.

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R1-Resektion in der Chirurgie des oberen Gastrointestinaltrakts

Cited by 13 publications

References 36 publications

Methylated DAPK and APC promoter DNA detection in peripheral blood is significantly associated with apparent residual tumor and outcome

Methylated DAPK and APC promoter DNA detection in peripheral blood is significantly associated with apparent residual tumor and outcome

Gastric cancer: surgery in 2011

Chirurgie des Magenkarzinoms: Standards und Innovationen – Von der primären Chirurgie zu multimodalen, individualisierten Strategien

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