Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

Abstract

The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.

Is There an Indication for Surgical Resection in Colorectal Adenoma?

“…3 , 4 ). Based on our experience, we cannot confirm reports about complicated courses after ink labelling [ 22 ]. According to the current German guideline for colorectal carcinoma (S3-Leitlinie Kolorektales Karzinom), labelling with ink or clips is obligatory [ 28 ].…”

“…In our clinic, we tend to prefer open resection with a limited transverse incision in the right abdomen if a highly suspicious tumor is located in the right colon. When indicated, the operation is performed as a hybrid intervention where laparoscopic mobilization of the right colon leads to a shorter incision (laparoscopically assisted) [ 22 ].…”

“…Herein, transanal surgery shows clear advantages compared to endoscopic piecemeal resections. Especially in the supraanal region, where transanal full-thickness resections can include also mesorectal fat and lymph nodes, further advantages arise for the patient: In early cancer, deep rectal resection with coloanal anastomosis and even abdominoperineal resection can be avoided [ 22 ]. In the case of a low-risk situation with invasion of the superficial layers (<1,000 µm) of the submucosa, the risk of lymph node metastasis is about 6% [ 30 , 31 ].…”

“…Their extent and texture interfere with any type of limited procedure, which in turn results in piecemeal resections or multiple resections. Here, an interdisciplinary discussion considering the patient's interests is essential [ 22 ].…”

Application of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry technology for the diagnosis of colorectal adenoma

“…The ‘adenoma-cancer sequence’ is a well-known hypothesis, which states that the detection of an adenoma followed by a resection may markedly reduce the incidence of colorectal cancer (18,19). …”