Chirurgische Konzepte zu Prävention und Therapie von Präkanzerosen und Frühkarzinomen des Ösophagus

Abstract

Surgical Concepts for Prevention and Therapy of Precanceroses and Early Carcinomas of the Esophagus Recently, precancerosis and early stage carcinoma of the esophagus and the cardia gained popularity. It is not only the epidemiology and diagnostic procedures which have changed, but also the therapeutic options and concepts. Meanwhile it is known that 5–10 years of pathologic exposition to toxic reflux are necessary to cause intestinal metaplasia. Basic thoughts for the development from intestinal metaplasia to carcinoma might be gall – and pancreatic juice refluxing into the esophagus. Gold treatment standard for the non-dysplastic Barrett’s esophagus is either medical by proton pump inhibitors or surgical by antireflux surgery. None of the named therapeutic concepts can prevent development from metaplasia into malignancy definitely. In the treatment of intraepithelial neoplasia, various alternatives, from modern endoscopic mucosa resection up to the radical subtotal esophageal resection followed by lymphadenectomy, are well described.