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Surgical oncology of the upper gastrointestinal tract

Team of doctors:
Ao. Univ.-Prof. Dr. Heinz Wykypiel, FEBS/FEBTS UGI
Priv.-Doz.in Dr.in Pamela Kogler
Priv.-Doz. Dr. Reinhold Kafka-Ritsch

Special consultation hours:
Thursday 09:00 -14:00
Tel. +43 (0)50 504 50010

The gastrointestinal oncology section deals with the diagnosis and treatment of malignant tumors (cancer) of the gastrointestinal tract (esophagus, stomach, small intestine, large intestine and rectum), the peritoneum (peritoneum) and sarcomas (malignant soft tissue tumors) of the abdominal cavity.

Esophageal carcinoma (cancer of the esophagus)

Malignant tumors of the esophagus are relatively rare (about 25 new cases per year in Tyrol) and, due to the anatomical characteristics of the esophagus, represent a special therapeutic challenge for the treating physicians on the interdisciplinary Tumor Board. In the ideal case, the findings are a random finding within the scope of an endoscopy.

(esophagogastroduodenoscopy): in this situation, endoscopic ablation of the tumor may already be sufficient. In most cases, however, tumors of the esophagus are only diagnosed at an advanced stage: patients often exhibit typical symptoms such as difficulty swallowing and unintentional severe weight loss. If other organs (e.g. lungs, liver) or vital structures (e.g. aorta, pericardium) are already affected by the tumor, surgery is no longer an option. In order to determine this and to be able to select the best treatment for each patient, extensive examinations such as computer tomography (CT), positron emission tomography (PET), bronchoscopy and endosonography are performed. The therapy of choice for patients with esophageal cancer is the removal of the esophagus through a technically complex (minimally invasive) operation with opening of the abdominal cavity and chest cavity, in which the tumor-affected esophagus is replaced with a stomach tube. Depending on the stage of the disease, radiation therapy (radiotherapy) and chemotherapy are performed in addition to the operation.

All patients operated on in our clinic are checked in the consultation hours for gastrointestinal tumors, initially every 3 months, then every six months and later annually.

Stomach carcinoma (stomach cancer)

Since stomach cancer rarely shows early or warning symptoms, it is usually discovered by chance during a gastroscopy (gastroscopy). If the diagnosis is confirmed by a biopsy (removal of tissue) with subsequent microscopic examination, further examinations - primarily a computer tomography (CT) and endosonography - must be carried out in order to plan the best possible therapy for each patient. Depending on the constellation of findings, the therapy is either primary surgery or primary chemotherapy with subsequent surgery. The decision on the recommended treatment scheme depends on the size and extent of the gastric carcinoma and is the responsibility of the weekly interdisciplinary gastrointestinal tumor conference. If possible from an oncological point of view - the internationally valid radicality criteria of surgery for stomach cancer are strictly adhered to at our clinic - we strive to preserve a residual stomach, as the quality of life is significantly better compared to total removal of the stomach (gastrectomy). In addition, our department performs extensive lymph node dissection ("D2 dissection") as a standard procedure, since our complication rates are comparatively low and we are convinced of the usefulness of this more radical surgery. As a rule, removal of the spleen is not necessary. We pay special attention to nutritional counseling after the operation, where the patient is supported by trained dietitians. Depending on the constellation of findings, chemotherapy may be necessary after the operation. All patients operated on by us are checked in the consultation hours for gastrointestinal tumors, initially every 3 months, then every six months and later annually.

Tumors of the small intestine (cancer of the small intestine)

Cancer of the small intestine, a rare type of cancer compared to cancer of the large intestine or stomach, is a disease in which cancer cells are found in the tissue of the small intestine. Often an x-ray examination of the upper digestive tract (gastrointestinal passage) is ordered to detect diseases of the small intestine. Computer tomography and/or magnetic resonance imaging (MRI) can also be very helpful in the diagnosis of tumors of the small intestine. These tumors repeatedly reveal themselves as the cause of intestinal obstruction and are often only discovered by chance during emergency surgery. Depending on which cells are the starting point of the malignant degeneration in the small intestine, there are completely different types of cancer with different treatment strategies and, above all, different prognosis (carcinomas, neuroendocrine tumors, gastrointestinal stromal tumors, lymphomas, ...). Since the main symptoms of small intestinal tumors are often bleeding or intestinal obstruction, or at least the preliminary stage thereof, surgical removal of the tumor must almost always be performed, regardless of the type of cancer. Whether subsequent chemotherapy or other drug therapy is necessary is decided in the interdisciplinary gastrointestinal tumor conference. All patients operated on by us are checked in the consultation hours for gastrointestinal tumors, initially every 3 months, then every six months and later annually.

Gastrointestinal Stromal Tumor (GIST)

Gastrointestinal stromal tumors (GIST) are rare tumors of the gastrointestinal tract, representing about 80% of malignant soft tissue tumors of the gastrointestinal tract. Currently, the incidence is estimated to be approximately two per 100,000 population. GISTs are distributed throughout the entire gastrointestinal tract (esophagus 5%, stomach 40%-70%, duodenum 6%, small intestine 20%-35% and in the large intestine and rectum 5%-15%). Due to this varying incidence, the diagnosis is also very different: during emergency surgery due to intestinal obstruction or intestinal rupture, due to bleeding in the digestive tract or abdomen, but also as a chance finding during surgery or during a gastroscopy or colonoscopy. In total, approximately 80% of all GISTs are diagnosed by endoscopy. However, before treatment can be planned, further special examinations (CT, MRI, PET, endosonography) must be performed to better assess the disease and especially its extent. If GISTs are limited to the organ of origin, i.e. there have been no metastases, surgical removal is the therapy of choice. In contrast to carcinomas, limited, organ-saving surgery is usually sufficient for GISTs. For advanced diseases, surgery must be combined with modern targeted drugs (Glivec, Sutent). Whether and when (before and/or after surgery) these drugs are used is decided jointly in our interdisciplinary gastrointestinal tumor conference. All patients operated on by us are checked in the consultation hours for gastrointestinal tumors, initially every 3 months, then every six months and later annually.