Die R1-Resektion beim Rektumkarzinom

Abstract

R1 resections in rectal cancer particularly affect the circumferential resection margin (CRM) and lead to increased local recurrence rates, more distant metastases and a poorer prognosis. The proximity of the tumor to the CRM is already sufficient to increases these risks; therefore, according to the guidelines, it is now necessary to distinguish between R0 wide (≥1 mm distance), R0 close (<1 mm) and R1. The surgical technique is decisive for avoiding R1 situations. The preparation follows the boundary layers and envelope fascia in a standardized radical way and if necessary deviates away from these structures and the tumor under en bloc resection of neighboring structures. Neoadjuvant therapy also contributes to the reduction of R1 situations but cannot compensate for inadequate surgical procedures.

Are Colon and Rectal Cancer Two Different Tumor Entities? A Proposal to Abandon the Term Colorectal Cancer

“…The surgical principles follow the tumor location and involve right/left hemicolectomies, and transversal or sigmoid/rectosigmoid resection [ 90 ]. RC surgery is methodically more complex, and the surgical demands increase with the depth of the aboral tumor position and closer to the sphincter muscle [ 3 , 8 , 91 ]. Tumors localized in the lower two thirds of the rectum which receive a sphinkter-preserving procedure usually also need a move to improve continence in form of a pouch procedure [ 3 ].…”

“…Consequently, RC surgery is associated with higher morbidity/mortality and with higher local relapse rates than CC surgery [ 91 , 92 , 93 , 94 ]. Specific postoperative morbidity in a large prospective observational study by the “Institute for Quality Assurance, Magdeburg” involving 3756 Patients was 21.8% in resected CC patients and 29.1% in resected RC patients.…”

The role of intraoperative radiotherapy in advanced rectal cancer: a meta‐analysis

“…Unfortunately, a proportion of patients will have threatened margins making a complete resection (R0) difficult. Where rectal cancer is incompletely resected, patients experience high rates of local failure, distant metastasis and mortality [5,6].…”

“…cancer is incompletely resected, patients experience high rates of local failure, distant metastasis and mortality [5,6].…”