MEDIX, God. 19 Br. 107/108  •  Pregledni članak  •  Gastroenterologija/Onkologija HR ENG

Suvremene smjernice u kirurškom liječenju karcinoma želucaCurrent guidelines for the surgical treatment of gastric cancer

Ana Car Peterko, Miroslav Bekavac-Bešlin

Karcinom želuca četvrti je najčešći malignom i drugi najčešći uzrok smrti od malignih bolesti. Točna etiologija nije poznata. Način prehrane i infekcija želučane sluznice bakterijom H. pylori smatraju se najznačajnijim čimbenicima rizika za nastanak sporadičnoga karcinoma, a genske mutacije imaju za posljedicu razvoj familijarnoga karcinoma. U 95% slučajeva maligni tumor želuca je adenokarcinom i najčešće zahvaća srednju i distalnu trećinu želuca. Kliničko-patološka Laurenova i TNM-klasifikacija determiniraju liječenje koje uvijek zahtijeva multidisciplinaran pristup. Međutim, jedino kurativno liječenje jest radikalna kirurška resekcija (distalna i proksimalna resekcija želuca, gastrektomija i ezofagogastrektomija) sa sistemskom limfadenektomijom. Uz standardne resekcije rani rak želuca uspješno se liječi i poštednijim endoskopskim metodama (mukozna resekcija i submukozna disekcija). S obzirom na to da u 80% slučajeva bolesnik nema nikakve simptome u ranoj fazi, bolest se uglavnom dijagnosticira u već uznapredovaloj fazi i ima lošu prognozu (petogodišnje preživljenje je 15–25%). Iznimka su Japan i zemlje istočne Azije gdje se u 50% slučajeva bolest otkriva u ranoj fazi, kad je prognoza petogodišnjega preživljenja veća od 90%. 

Ključne riječi:
adenokarcinom želuca; gastrektomija; limfadenektomija; rani rak želuca; subtotalna resekcija

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 19 Br. 107/108

Gastric cancer is fourth most common malignant neoplasm, and the second most common cause of death caused by malignant diseases. The exact etiology is unknown. Dietary habits and H. pylori infection affecting the gastric mucosa are the two major risk factors for the development of sporadic gastric cancer, while genetic mutations cause the development of familial cancers. Adenocarcinoma is the most common gastric cancer, and is found in 95% of gastric cancer cases. It affects the middle and distal third part of the stomach. Clinicopathological Lauren classification and TNM classification determine the type of treatment needed, but multidisciplinary approach is always required. However, the only curative treatment is surgical resection (distal and proximal gastric resection, gastrectomy and esophagogastrectomy) accompanied by systematic lymphadenectomy. In addition to standard resections, early gastric cancer can be successfully treated with endoscopic methods (mucosal resection and submucosal dissection). Taking into consideration that 80% of patients are asymptomatic in the early stages of the disease, the disease is often diagnosed at an advanced stage and with poor prognosis (5 year survival rate is only 15-25%). The exceptions are Japan and countries of East Asia, where 50% of patients are diagnosed in the early stages of the disease and the 5 year survival rate is higher than 90%. 

Key words:
early gastric cancer; gastrectomy; gastric adenocarcinoma; gastric distal resection; lymphadenectomy