Abstrakt

While surgical treatment of Barrett’s neoplasia is an important component of multimodal concepts in locally advanced stages, it is increasingly taking a back seat in early-stage carcinomas due to the optimization of endoscopic resection techniques. In many cases, the combination of endoscopic resection and ablation of the remaining Barrett’s esophagus allows organ preservation. A decisive factor for or against surgical therapy in the case of early neoplasia is the probability of lymph node metastases in the individual case, as these can only be detected to a very limited extent in pre-therapeutic staging. Sentinel lymph node concepts are not currently established for Barrett’s carcinoma. The standard surgical procedure for locally advanced stages is abdominothoracic esophageal resection with 2-field lymphadenectomy and pull-up of a gastric tube as part of a multimodal therapy concept. This operation can be performed in high-volume centers with very low mortality rates and good long-term quality of life. The importance of prophylactic clearance of the lymph nodes of the upper thoracic aperture is currently the subject of controversial debate. The added value of minimally invasive procedures in esophageal resection is evidence-based. There are initial indications of a further advantage of robotic procedures. The widespread adoption of robotic esophageal resection worldwide suggests that this will become the standard procedure in the future. If the formation of a gastric tube is not possible due to previous operations or for oncological reasons because tumor-free status cannot be achieved aborally, colon interposition is an established procedure that can also achieve a good quality of life. If T1 carcinomas are not resectable endoscopically, there is the option of limited resection of the proximal stomach and distal esophagus. Whether this significantly improves the functional outcome cannot be conclusively assessed at present.

Autoreninformation

Autoren

• K. Beyer

Abteilungen

• Klinik für Allgemein-, Viszeral-, Transplantations- und Thoraxchirurgie, Allgemein- und Viszeralchirurgie, Universität Augsburg, Augsburg

Adresse

Prof. Dr. med. Katharina Beyer
Klinik für Allgemein-, Viszeral-, Traansplantations- und Thoraxchirurgie
Universitätsklinikum Augsburg
Universität Augsburg
Stenglinstraße 2
86156 Augsburg
Email: [email protected]

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