Evidenz in der minimal-invasiven onkologischen Chirurgie des Kolons und des Rektums

Evidence in minimally invasive oncological surgery of the colon and rectum

Zusammenfassung

Wesentlicher Bestandteil der Therapie des kolorektalen Karzinoms ist die Resektion des tumortragenden Darmsegments. Mit der Entwicklung minimal-invasiver Verfahren stellt sich die Frage nach Anwendbarkeit und Sicherheit derselben im onkologischen kolorektalen Setting. Die breite Studienlage der letzten Jahre zeigt für das Kolonkarzinom weitgehend konsistent Vorteile in der perioperativen Phase bei Nichtunterlegenheit bez. onkologischer Aspekte im Langzeitverlauf. Die Implementierung der laparoskopischen Rektumresektion erfolgte bedingt durch die Komplexität des Eingriffs und die unzureichende Studienlage deutlich zögerlicher. Insgesamt erscheint jedoch auch diese bei perioperativen Vorteilen, aber heterogenen Befunden im Hinblick auf die Resektatqualität langfristig dem offenen Verfahren nicht unterlegen. Dementsprechend hat eine Empfehlung für eine laparoskopische Resektion bei kolorektalem Karzinom auch in den Großteil der Leitlinien Einzug gehalten. Dabei trägt die Einschränkung bez. einer erreichbaren onkologischen Gleichwertigkeit nur bei hinreichender Expertise des Operateurs und rationaler Patientenselektion der Komplexität und den Anforderungen des Eingriffs Rechnung.

Abstract

An essential component of the treatment of colorectal cancer is a resection of the tumor-bearing segment of the bowels. After the development of minimally invasive procedures the feasibility and safety in oncological, colorectal surgery was questioned. The broad study situation for colon cancer over the last years showed predominantly consistent benefits during the perioperative phase and non-inferiority concerning long-term oncological outcomes. The implementation of laparoscopic rectal resection was more hesitant due to the complexity of the procedure and insufficient study data; however, overall the short-term benefits seem to be maintained and laparoscopic rectal resection is thought to be noninferior to open resection in the long run even though findings on the quality of the resected specimen are heterogeneous. Accordingly, most guidelines now include a recommendation of laparoscopic resection for colorectal cancer. The limitation with respect to an achievable oncological equivalency of resection takes account of the complexity and the requirements of the intervention only in the setting of rational selection of patients and sufficient experience of the surgeon.

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Correspondence to PD Dr. Armin Wiegering.

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C. Kastner, J. Reibetanz, C.‑T. Germer und A. Wiegering geben an, dass kein Interessenkonflikt besteht.

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C.T. Germer, Würzburg

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Kastner, C., Reibetanz, J., Germer, CT. et al. Evidenz in der minimal-invasiven onkologischen Chirurgie des Kolons und des Rektums. Chirurg (2020). https://doi.org/10.1007/s00104-020-01320-6

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Schlüsselwörter

  • Kolorektales Karzinom
  • Laparoskopie
  • Offene Chirurgie
  • Outcome
  • Karzinomstadium

Keywords

  • Colorectal cancer
  • Laparoscopy
  • Open surgery
  • Outcome
  • Cancer stage