Stellenwert der Rektumexstirpation im Therapiekonzept des tief sitzenden Rektumkarzinoms

Marusch, F.; Koch, Andreas; Schmidt, Uwe; Meyer, L.; Steinert, R; Pross, M.; Köckerling, F.; Bauer, H; Schönleben, K.; Hj, Halbfass; Scheele, J.; Gastinger, I.; Lippert, H.; Kolon, Studiengruppe; Karzinome, Rektum

doi:10.1007/s00104-002-0579-1

Cited by 26 publications

(17 citation statements)

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“…The significant impact of independent variables on the type of the selected approach was determined by means of logistic regression. Results While in total 422 primary Hartmann's procedures (4.8%) were executed under curative intention, 213 (50.5%) of those were carried out in emergency situBy means of a prospective multicentre observational study, treatment results of carcinoma of the left colon from 309 participating clinics of each profile (spanning from regional to university hospital) were evaluated over a time period from 1 January 2000 to 31 December 2002 (study design according to Marusch et al [1,2]). The questionnaire contained 68 items on the perioperative course and tumour histology.…”

Section: F Meyer • F Marusch • a Koch • L Meyer • S Führer • F mentioning

confidence: 99%

Emergency operation in carcinomas of the left colon: value of Hartmann?s procedure

et al. 2004

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Section: F Meyer • F Marusch • a Koch • L Meyer • S Führer • F mentioning

confidence: 99%

Emergency operation in carcinomas of the left colon: value of Hartmann?s procedure

et al. 2004

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“…Although the depth distribution of rectal carcinoma remained unaltered during the study period, a significant decrease in the abdominoperineal resection rate was observed (from 27.6 to 22.3%; table 4). In an earlier study by our group, it was shown that the frequency of abdominoperineal resection -along with the tumour location and the depth of invasion -was influenced decisively by the hospital volume [11,12]. Therefore, these results are relevant for the current debate about the introduction of minimum case load.…”

Section: Long-term Oncological Results -Colon and Rectum Carcinomamentioning

confidence: 73%

Quality of Medical Care in Colorectal Cancer in Germany

Kube

Ptok²,

Wolff³

et al. 2009

Oncol Res Treat

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Background: To investigate recent developments in therapeutic approaches, we examine the quality of and discuss current trends in the routine treatment of colorectal cancer in Germany. Material and Methods: We conducted a prospective, multicentre, country-wide observational study in Germany at a representative number of hospitals providing care at all levels. Results: The perioperative morbidity and mortality rates were found not to have changed for a given risk profile of patient and tumour characteristics. The resection rates and long-term oncological results achieved in clinical routine are comparable with those reported in the current literature for colorectal cancer. The quality of care of rectal carcinoma patients has improved significantly, as measured by perioperative oncosurgical criteria (abdominoperineal resection rate, total mesorectal excision rate and quality, and proportion of neoadjuvant procedures). Conclusion: At present, it remains to be seen whether these factors will lead to a further improvement in long-term results (e.g. rates of local recurrence), and this will require further critical analysis.

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“…Darüber hinaus wird sie bei schlecht-oder entdifferenzierten sowie muzinösen Karzinomen häufiger beobachtet [83]. Prinzipiell ist anzunehmen, dass eine intramurale Tumorausbreitung nach distal -sowohl kontinuierlich als auch diskontinuierlich -erst im fortgeschrittenen Tumorstadium mit entsprechender ungünstiger Prognose erfolgt, wenn die Metastasierungswege nach proximal mit Tumorzellen obliteriert sind [19,52].…”

Section: Distale Resektionsgrenzen An Der Darmwandunclassified

“…Die Zentren, die seit Jahren die TME als Dissektionsprinzip bei Karzinomen des mittleren und unteren Rektumdrittels anwenden, berichten über Lokalrezidivraten bei kurativ behandelten Patienten, die deutlich unter 10% liegen [4,6,11,25,27,32,36,52,62,103]. Vergleicht man diese Ergebnisse mit den Resultaten aus der Ära vor der TME, so zeigt sich eindrücklich, dass die Lokalrezidivrate durch die TME signifikant gesenkt werden konnte: So erniedrigte sich bei Dahlberg et al die Lokalrezidivrate von 14% (1985-1989, ohne TME) auf 5% (1990-1995, mit TME), Arbman et al berichten, dass die Lokalrezidivrate von 14,2% (1984-1986, ohne TME) auf 6,3% (1990-1992, mit TME) gesenkt werden konnte [3,14].…”

Section: Ergebnisse Der Tme Im Literaturvergleichunclassified

“…Nur so wird die TME eine größere Akzeptanz erlangen, nur so lassen sich Lokalrezidivraten von 30% infolge inkompletter Mesorektumexzision in Zukunft vermeiden. Hinsichtlich der Dokumentation und Qualitätskon-trolle sowie der zu erstellenden Leitlinien sind noch Defizite vorhanden, die möglichst rasch beseitigt werden müs-sen, wenn man die publizierten Daten zur chirurgischen Therapie des Rektumkarzinoms als Grundlage nimmt [18,40,41,45,51,52].…”

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Chirurgische Therapie des Rektumkarzinoms

et al. 2003

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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.

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Stellenwert der Rektumexstirpation im Therapiekonzept des tief sitzenden Rektumkarzinoms

Cited by 26 publications

References 25 publications

Emergency operation in carcinomas of the left colon: value of Hartmann?s procedure

Emergency operation in carcinomas of the left colon: value of Hartmann?s procedure

Quality of Medical Care in Colorectal Cancer in Germany

Chirurgische Therapie des Rektumkarzinoms

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