Özofagogastrik Bileşke Kanserleri ve Cerrahi Tedavisi

Proksimal mide ve özofagogastrik bileşke (ÖGB) adenokarsinomu sıklığı özellikle batı dünyasında artma eği- limindedir. 1998 yılında özofagogastrik bileşke adenokarsinomları için Siewert sınıflaması yayınlandı. Sınıf- lama esas olarak tümörün topografik özelliklerine dayanır. AJCC'nin 7. Kanser Evreleme Kılavuzu'nda özofa- gogastrik bileşke kanserleri ve bileşkeye ya da distal özofagusa uzanan 5 cm'lik proksimal gastrik kanserleri de özofagus kanseri sınıflamasına dahil edilmektedir. Tip 1 tümörlerde en sık lenfatik yayılım paraözofagiyal, üst abdominal lenf nodlarına olur. Tip II ve III tümörlerde mediastinal lenf nodu metastazı görülme sıklığı tip I tümörlere göre daha düşük olup, ileri evre hastalarda görülebilir. Genel durumu iyi, uzak metastazı olmayan, Rezektabl ÖGB adenokarsinomlarında en iyi tedavi cerrahidir. Seçilecek cerrahi yöntem konusunda, tip I tü- mörler için transtorasik fundektomi ve subtotal özofajektomi (İvor Lewis operasyonu), tip III tümörler için D2 diseksiyonla genişletilmiş gastrektomi yapılması konusunda literatürde, geniş ölçüde fikir birliği olduğu gö- zükmektedir. Yayınlanan çalışmalar ışığında tip II tümörler için eğer hiatustan tümörün proksimal uzanımı R0 çıkarılabilecekse genişletilmiş gastrektomi yapılması, R0 rezeksiyon yapılamıyacaksa abdominal-sağ transto- rasik yaklaşımla ( İvor Lewis operasyonu) rezeksiyon uygulanması uygun gözükmektedir. Submukozal tümör- lerde endoksopik tedavi yöntemleri uygulanabilir.

Esophagogastric Junction Carcinoma and Surgical Treatment

Proximal gastric and esophagogastric junction adenocarcinomas (EGJA) are arising in especially western world. In 1998 Siewert published his classification for EGJA which is based on tumors tophography. The 7th edition of AJCC Cancer Staging Manuel includes staging of esophagus and esophagogastric junction cancer also the first 5 cm of the stomach cancer that invades the esophagogastric junction. For type I tumors the most frequent lymphatic spread is through the paraesophageal and upper abdominal lymph nodes. For type II and type III tumors mediastinal lymphatic invasion frequency is lower. The best treatment for R0 resectable EGJA without metastases is surgery. It is widely accepted that for type I tumors Iwor Lewis operation, for type III tumors transabdominal total gastrectomy with D2 lymph node dissection are the best treatment. For type II tumors if R0 resection is possible via transabdominal approach, total gastrectomy is appopriate. If R0 resec- tion is not possible with this way, transabdominal and transthorasic esophagectomy should be done with two field lymphadenectomy. Endoscopic resection can be done for submucoal tumors.

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Ankara Üniversitesi Tıp Fakültesi Mecmuası-Cover
  • Başlangıç: 1947
  • Yayıncı: Erkan Mor
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