Die perioperative Chemotherapie des lokal fortgeschrittenen Magenkarzinoms nach Göttinger Erfahrung

Die perioperative Chemotherapie des lokal fortgeschrittenen Magenkarzinoms nach Göttinger Erfahrung

Perioperative chemotherapy of locally advanced gastric carcinoma based on the experiences of Göttingen medical school

Röper, Dierck-Henrik

Dissertation

Angenommen am: 2012-06-20

Erschienen: 2012-06-08

Betreuer: Ramadori, Giuliano Prof. Dr. Dr. h.c.

Gutachter: Ramadori, Giuliano Prof. Dr. Dr. h.c.

Gutachter: Liersch, Torsten PD Dr.

Gutachter: Mausberg, Rainer Prof. Dr.

Zum Verlinken/Zitieren: http://hdl.handle.net/11858/00-1735-0000-000D-EFC7-1

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Zusammenfassung

Englisch

Background Recent studies demonstrated an improved outcome of patients with resectable adenocarcinoma of the stomach treated with a perioperative chemotherapy compared with surgery alone. Besides, a maximum number of resected lymph nodes including D2 and D3 resections seem to correlate with a higher likelihood of overall survival. This study evaluates the course and the benefit of a methodic perioperative chemotherapy and radicality of lymphadenectomy by contrasting these parameters with international published studies. Methods Between November 2007 and July 2010, 20 patients with locally advanced gastric cancer were detected by endoscopy of the upper gastrointestinal tract with a simultaneous sampling from suspect areas of the gastric mucosa. Subsequently, 17 patients underwent a neoadjuvant chemotherapy followed by gastrectomy. The present study evaluates tumor remission by preoperative chemotherapy, number of cycles,lapse of time between the cycles and the gastrectomy as well as postoperative survival. To assess the surgical radicality, the extent of lymphadenectomy, the lymph node ratio plus the duration of gastrectomy were analyzed among all surgical interventions. A comparison between staging precision of endoscopic ultrasound (EUS) and computertomography (CT) allows an evaluation of preoperative lymph node diagnostics. Results Tumor remission rate after perioperative chemotherapy was 88.2% among all patients. The average interval between preoperative chemotherapy and gastrectomy was 47.5 days. 18 months after surgical intervention in 56.25% of all patients no death has been reported. There was no case of immediate postoperative death. The median lymph node ratio was 17.7%. Average time for a gastrecteomy including lymphadenectomy was 180.75 minutes. Both CT and EUS showed a sensitivity of 37.5% in determining the N-category. Lessons learned are consistent with the results of current studies regarding the benefit of perioperative chemotherapy. A high prognostic relevance of a low LNR is supported by supported by this work.

Keywords: Gastric carcinoma gastrectomy lymph node ratio

Weitere Sprachen

Hintergrund Aktuelle Studien zeigen für Patienten mit resektablem Magenkarzinom einen Prognosevorteil hinsichtlich des Gesamtüberlebens bei zusätzlicher perioperativer Chemotherapie verglichen mit chirurgischer Resektion alleine. Ebenso scheint eine größtmögliche Anzahl resektierter Lymphknoten unter Einbeziehung des 2. und 3. Drainagekompartiments mit einem Prognosevorteil verbunden zu sein. Diese Arbeit bewertet den Verlauf und den Benefit einer perioperativen Chemotherapie sowie die Radikalität der Lymphadenektomie und stellet diese Parameter international publizierten Daten gegenüber. Methoden Zwischen November 2007 und Juli 2010 wurde in der Abteilung für Gastroenterologie und Endokrinologie bei 20 Patienten mittels

Schlagwörter: Magenkarzinom Lymphadenektomie Lymphknotenbefallsrate