Schmidt T, Mönig S P
Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
Department of Surgery, Upper-GI-Surgery, Geneva University Hospitals, Geneva, Schweiz.
Chirurg. 2017 Dec;88(12):1024-1032. doi: 10.1007/s00104-017-0548-3.
The therapeutic approach to patients with oligometastatic gastric cancer and esophageal cancer is currently undergoing a shift towards a more aggressive therapy including surgical resection. In the current German S3 guidelines surgical treatment of metastatic disease is not recommended; however, nowadays interdisciplinary tumor boards have to evaluate such patients increasingly more often. On an individual basis a radical surgical resection of the primary tumor and the metastases is considered and performed in patients who respond well to multimodal chemotherapy concepts. In this review article the currently available data from the literature are discussed and a foundation for individually extended surgical approaches is presented. Together with the currently available results of the FLOT 3 study and the mostly retrospective studies, it seems to be possible to identify patients who would profit from such an aggressive treatment. In the future randomized prospective studies, such as the RENAISSANCE/FLOT 5 study and the GASTRIPEC study will have to evaluate whether an aggressive surgical therapy within multimodal therapy concepts of metastatic gastric and esophageal carcinomas is warranted.
目前，寡转移性胃癌和食管癌患者的治疗方法正朝着更积极的治疗方向转变，包括手术切除。在当前的德国S3指南中，不建议对转移性疾病进行手术治疗；然而，如今跨学科肿瘤委员会不得不越来越频繁地评估此类患者。在个体层面上，对于对多模式化疗方案反应良好的患者，会考虑并实施对原发性肿瘤和转移灶的根治性手术切除。在这篇综述文章中，讨论了目前文献中的可用数据，并为个体化的扩大手术方法奠定了基础。结合FLOT 3研究的现有结果以及大多数回顾性研究，似乎有可能识别出能从这种积极治疗中获益的患者。在未来的随机前瞻性研究中，如RENAISSANCE/FLOT 5研究和GASTRIPEC研究，将必须评估在转移性胃癌和食管癌的多模式治疗概念中积极的手术治疗是否合理。
