Chirurgische Therapie des Rektumkarzinoms

Abstract

Total mesorectal excision (TME) has gained a revolutionary impact on the surgical therapy of rectal cancer within the last 2 decades, providing superior local tumor control in comparison to conventional resection. Consequently, 85% of rectal carcinomas can be resected by sphincter-preserving surgery without compromising either oncologic radicality or continence. With the introduction of TME, local recurrence rates have been reliably decreased below 10% after curative resection. Surgical dissection along the connective tissue space between rectal and parietal pelvic fascia with complete mesorectal excision results in reliable excision of all relevant lymphatic pathways with preservation of continence and sexual function. Complete removal of a TME specimen is mandatory in carcinomas of the middle and lower third of the rectum. Both removal of the complete TME specimen and careful pathologic examination of the circumferential resection margin have decisive significance. An additional pelvic lymphadenectomy with the potential risk of increased morbidity does not improve prognosis. As a spread of tumor distally along the bowel wall rarely exceeds a few centimeters, a distal resection margin of 1-2 cm is oncologically sufficient in sphincter-saving procedures without compromising prognosis. Taken together, the convincing results of TME provide a rationale for using TME as the dissection policy of choice to resect rectal cancers in the distal two-thirds of the rectum, despite the absence of direct evidence from prospective randomized trials. The question whether laparoscopic curative resection for rectal cancer is oncologically adequate cannot be definitely answered to date, as results of randomized studies are currently missing. However, the preliminary results of laparoscopic resection for rectal cancer provided by centers are promising.

Kolorektale Karzinome bei unter 40-j�hrigen Patienten

“…Resektion bzw. Operationstechnik ebenso wie zur Tumornachsorge bereits veröffentlicht worden sind [6][7][8][9][10].…”

Welche Rolle spielt der programmierte Zelltod (Apoptose) beim Rektumkarzinom?

“…Alle kurativen Resektionen wurden nach onkologischem Standard vorgenommen, bei Karzinomen des mittleren und unteren Rektumdrittels in Form einer totalen mesorektalen Exzision (TME). Details zur Operationsindikation und -technik der eigenen Klinik beim Rektumkarzinom sind bereits dargestellt worden [13][14][15]. Nach einem mittleren Follow-up von 38 Monaten kam es bei 20% der Patienten (n = 32) zu einer Tumorprogression: Lokalrezidive wurden in zehn Fällen beobachtet, Fernmetastasen traten in 22 Fällen auf.…”

Isolierte metachrone Fernmetastasen ungew�hnlicher Lokalisation nach kurativer Resektion beim kolorektalen Karzinom*

“…Operationstechnik ebenso wie die Tumornachsorge bereits veröffentlicht worden sind [13][14][15][16].…”