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Bildgebung vor kolorektaler Chirurgie aus Sicht des Chirurgen

Preoperative imaging for colorectal cancer: surgeons’ perspective

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Zusammenfassung

Die präoperative radiologische Diagnostik bei Patienten mit kolorektalen Karzinomen hat mehrere Ziele. Die Lokalisationsdiagnostik bei Kolonkarzinomen ist für die Planung des Resektionsausmaßes unentbehrlich. Die radiologisch vermutete Infiltration der Nachbarstrukturen kann eine Entscheidung für die neoadjuvante Behandlung bedingen. Bei Patienten mit Rektumkarzinomen müssen das T‑ und das N‑Stadium, der Abstand zum zirkumferenziellen Resektionsrand (CRM) und die Eindringtiefe des Tumors ins Mesenterium bestimmt werden. Davon wird abhängig gemacht, ob der Patient neoadjuvant behandelt wird. Vor der geplanten Rückverlagerung eines vorgeschalteten Stomas kann die radiologische Diagnostik additiv zur klinischen und endoskopischen Untersuchung erfolgen, jedoch sollte sie nicht routinemäßig angewendet werden.

Abstract

Preoperative radiological diagnostics in patients with colorectal cancer has several objectives. The diagnostic localization of the colonic tumor is essential for planning the resection. The radiologically suspected infiltration of neighboring structures may lead to the decision for neoadjuvant treatment. In patients with rectal carcinomas, the T and N stages, the distance to the circumference resection margin (CRM), and the penetration of the tumor into the mesentery must be determined. This crucial to determine whether the patient should undergo neoadjuvant treatment. Prior to the planned relocation of an upstream stoma, radiological diagnostics may be added to clinical and endoscopic assessment but should not be routinely used.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland

    I. Iesalnieks & A. Agha

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  1. I. Iesalnieks
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Correspondence to I. Iesalnieks.

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Interessenkonflikt

I. Iesalnieks und A. Agha geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Iesalnieks, I., Agha, A. Bildgebung vor kolorektaler Chirurgie aus Sicht des Chirurgen. Radiologe 59, 786–790 (2019). https://doi.org/10.1007/s00117-019-00582-4

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