Ösophagus- und Magenkarzinom - Chirurgische Therapie im interdisziplinären Kontext

Surgery is still the cornerstone in the curative treatment of esophageal and gastric cancer. However, pre-and postoperative treatment is influenced by other specialties nowadays. For accurate pretherapeutic staging endoscopy, endoluminal ultrasound and CT scan are necessary. Early esophageal and gastric cancer - mostly cT1a cancer with a limited probability of lymph node metastases - can be treated with endoscopic mucosa or submucosa resections. In case of positive resection margins or more advanced tumor categories such as pT1b, a surgical resection with lymphadenectomy should be recommended. Since more than 70 % of the tumors are diagnosed as cT3/4 tumors in Germany those patients are treated with pre- or perioperative treatment based on the tumor entity and localizations in cooperation with the oncologist or radiation oncologist. Nowadays even in limited metastatic gastroesophageal adenocarcinomas surgery is gaining more and more importance, but decisions for surgery are still individual and should be made interdisciplinary. In the postoperative course again based on tumor entity and localizations a relevant percentage of complications occur such as anastomotic leakage or abscesses, but most of them can nowadays be solved by interdisciplinary management with the help of endoscopists and radiologists. Therefore excellent surgical results improving patients' prognosis and quality of life can only be reached in close cooperation with other specialties.