Digestive disorders

III/4.6: Therapy

The treatment of operable tumors is based on surgical intervention, their removal together with an appropriate safe zone (so called R0 resection). A potential disruption of the tumor during surgery may cause peritoneal dissemination. Regarding the uncharacteristic lymphogenous propagation, no removal of the lymph nodes is necessary. A macroscopically radical resection is feasible in 3/4 of patients. In 1/5 to 1/4 of these cases, however, a radical resection cannot be confirmed microscopically. Small lesions can be removed by a submucosal or mucosal resection as well. Laparoscopic resection may also be performed in selected cases. No adjuvant therapy is recommended in patients who underwent a curative resection. Intraabdominal propagation or hepatic metastases occur in 20 to 40% of patients who underwent a surgical intervention. Postoperative recurrence occurs in 40 to 90% of patients. Close follow up is required for early recognition of a relapse.

One has to strive for performing surgery even if a regression occurs upon therapy, as a reduction of the tumor’s mass may enhance the effectiveness of the pharmacological treatment.