Munding Johanna, Tannapfel Andrea
Dtsch Med Wochenschr. 2016 Apr;141(9):613-9. doi: 10.1055/s-0042-100029. Epub 2016 Apr 28.
Since the implementation of a nationwide screening colonoscopy the incidence of colorectal adenocarcinoma is decreasing, while the amount of early endoscopically resectable tumours is increasing. Similarly malignant tumors of the upper gastrointestinal tract are diagnosed and resected endoscopically more often. In part, this also depends on improvements in technology.The current guidelines of diagnosis and treatment of squamous carcinoma and adenocarcinoma of the esophagus, gastric cancer and colorectal cancer exactly define, which lesions can be endoscopically resected curatively. This mostly depends on the risc of metastases in regional lymph nodes. The risc of a lymphatic spread can be asessed by histopathological characteristics depending on the localisation of the lesion. Substantially, these characteristics comprise the depth of invasion in the resection specimen and the status at the resection margins after the endoscopic resection as well as the tumor subtype and the histological grading of the tumor. In addition, an infiltration in lymphatic or blood vessels has to be taken into account.
自从全国范围内开展结肠镜筛查以来，结直肠癌的发病率在下降，而早期可通过内镜切除的肿瘤数量在增加。同样，上消化道恶性肿瘤通过内镜诊断和切除的情况也更为常见。部分原因也在于技术的进步。目前食管癌、胃癌和结直肠癌的鳞状细胞癌及腺癌的诊断和治疗指南明确规定了哪些病变可以通过内镜进行根治性切除。这主要取决于区域淋巴结转移的风险。淋巴转移风险可根据病变部位的组织病理学特征进行评估。实质上，这些特征包括切除标本中的浸润深度、内镜切除后切缘状态以及肿瘤亚型和肿瘤的组织学分级。此外，还必须考虑淋巴管或血管浸润情况。
