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Z Gastroenterol 2019; 57(12): 1517-1632
DOI: 10.1055/a-1018-2516
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York

S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL

Markus Moehler
,
Salah-Edin Al-Batran
,
Tilo Andus
,
Jann Arends
,
Dirk Arnold
,
Gustavo Baretton
,
Jan Bornschein
,
Wilfried Budach
,
Severin Daum
,
Christoph Dietrich
,
Matthias Ebert
,
Wolfgang Fischbach
,
Michael Flentje
,
Ines Gockel
,
Lars Grenacher
,
Jörg Haier
,
Stefan Höcht
,
Rolf Jakobs
,
Christian Jenssen
,
Barbara Kade
,
Stefan Kanzler
,
Jost Langhorst
,
Hartmut Link
,
Florian Lordick
,
Dietmar Lorenz
,
Sylvie Lorenzen
,
Manfred Lutz
,
Helmut Messmann
,
Hans-Joachim Meyer
,
Stefan Mönig
,
Katja Ott
,
Michael Quante
,
Christoph Röcken
,
Peter Schlattmann
,
Wolff-H. Schmiegel
,
Andreas Schreyer
,
Andrea Tannapfel
,
Peter Thuss-Patience
,
Arved Weimann
,
Susanne Unverzagt
Further Information

Publication History

Publication Date:
11 December 2019 (online)

Also available at
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Wesentliche Neuerungen durch die Aktualisierung der Leitlinie

Die Experten haben die gesamte Leitlinie durchgesehen und auf Aktualisierungsbedarf geprüft. Folgende Änderungen haben sich im Vergleich zur vorherigen Leitlinie von 2011 ergeben:

  • Risikofaktoren (Kapitel 3, 4, 5): Für den Risikofaktor H. pylori wurden Risikogruppen zur Eradikation und Krebsprävention definiert. Die genetische Klassifikation nach dem Cancer Genome Atlas TCGA wurde aufgenommen. Besondere Bedeutung haben die Charakterisierung von Patienten für die mit Mikrosatelliteninstabilität/HNPCC und Epstein-Barr-Virus assoziierten Tumoren.

  • Chirurgische Therapie (Kapitel 10–11): Die Laparaskopie ist ein zusätzlicher, wichtiger diagnostischer Schritt vor der perioperativen Therapie. Außerdem sind die Resektionsränder bei der Gastrektomie in Diskussion; in Einzelfällen kann hier von den Standards im Sicherheitsabstand abgewichen werden.

  • Neoadjuvante und palliative Chemotherapie (Kapitel 12–13): Als perioperatives Konzept hat sich FLOT etabliert. Als palliative Zweitlinientherapie ist Ramucirumab ggfs. in Kombination mit Paclitaxel zugelassen. Die Immuntherapie mit Checkpoint-Inhibitoren ist in Erprobung und nur bei MSI-Karzinomen sehr vielversprechend.

  • Supportive Maßnahmen (Kapitel 14, 15, 16, 17): Die Kapitel wurden für Ernährung und Lebensqualität konkretisiert und mit der S3-Leitlinie Supportivtherapie in Einklang gebracht. Mehr Information finden Sie unter dem folgenden Link: https://www.leitlinienprogramm-onkologie.de/leitlinien/supportive-therapie/

Eine genaue Aufstellung über die Veränderung der einzelnen Empfehlungen findet sich Kapitel 19.1.

 

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