Skip to main content
SpringerLink
Log in
Book cover

MRT-basierte Chirurgie des Rektumkarzinoms pp 115–128Cite as

Abdominoperineale Rektumexstirpationen

  • Chapter
  • First Online:

  • 1004 Accesses

Zusammenfassung

Die abdominoperineale Rektumexstirpation gehört seit mehr als 140 Jahren zum Armamentarium der Rektumkarzinomchirurgie. Zunächst etablierte sie sich als Standardeingriff, wurde dann wegen funktionell und onkologisch schlechterer Ergebnisse deutlich zurückgedrängt und stellt heute einen hochspezialisierten Eingriff für lokal weit fortgeschrittene Tumoren dar. Neben den technischen Verbesserungen gibt die moderne Bildgebung, insbesondere die MRT, dem Chirurgen das Rüstzeug an die Hand, den Tumor in Bezug auf die umgebenden Strukturen genau zu lokalisieren, eine sichere Differenzialindikation zwischen Sphinktererhalt oder notwendiger Exstirpation zu stellen und den Eingriff im Sinne der „MRI-guided surgery“ durchzuführen. Das folgende Kapitel erörtert diese Stichpunkte und stellt die chirurgische Technik dar.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Literatur

  • Aigner F, Zbar AP, Ludwikowski B, Kreczy A, Kovacs P, Fritsch H (2004) The rectogenital septum: morphology, function, and clinical relevance. Dis Colon Rectum 47:131–140

    Article  PubMed  Google Scholar 

  • Battersby NJ, How P, Moran B, Stelzner S, West NP, Branagan G, Strassburg J, Quirke P, Tekkis P, Pedersen BG, Gudgeon M, Heald B, Brown G, MERCURY II Study Group (2016) Prospective validation of a low rectal cancer magnetic resonance imaging staging system and development of a local recurrence risk stratification model: The MERCURY II study. Ann Surg 263:751–760

    Article  PubMed  Google Scholar 

  • Battersby NJ, Bouliotis G, Emmertsen KJ, Juul T, Glynne-Jones R, Branagan G, Christensen P, Laurberg S, Moran BJ (2017) Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut. https://doi.org/10.1136/gutjnl-2016-312695

    Article  PubMed  Google Scholar 

  • Christensen HK, Nerstrøm P, Tei T, Laurberg S (2011) Repair after extralevator abdominoperineal excision for low rectal cancer. Dis Colon Rectum 54:711–717

    Google Scholar 

  • Cong JC, Chen CS, Zhang H, Qiao L, Liu EQ (2012) Partial longitudinal resection of the anorectum and sphincter for very low rectal adenocarcinoma: a surgical approach to avoid permanent colostomy. Colorectal Dis 14:697–704

    Article  CAS  PubMed  Google Scholar 

  • De Campos-Lobato LF, Stocchi L, Dietz DW, Lavery IC, Fazio VW, Kalady MF (2011) Prone or lithotomy positioning during an abdominoperineal resection for rectal cancer results in comparable oncologic outcomes. Dis Colon Rectum 54:939–946

    Article  PubMed  Google Scholar 

  • Dehni N, McFadden N, McNamara DA, Guiguet M, Tiret E, Parc R (2003) Oncologic results following abdominoperineal resection for adenocarcinoma of the low rectum. Dis Colon Rectum 46:867–874

    Article  CAS  PubMed  Google Scholar 

  • den Dulk M, Putter H, Collette L, Marijnen CA, Folkesson J, Bosset JF, Rödel C, Bujko K, Påhlman L, van de Velde CJ (2009) The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomized clinical trials on rectal cancer. Eur J Cancer 45:1175–1183

    Article  Google Scholar 

  • Dixon CF (1948) Anterior resection for malignant lesions of the upper part of the rectum and the lower part of sigmoid. Trans Am Surg Ass 66:175–192

    CAS  Google Scholar 

  • Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255:922–928

    Article  PubMed  Google Scholar 

  • Enker WE, Merchant N, Cohen AM et al (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specially service. Ann Surg 230:544–552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Han JG, Wang ZJ, Wei GH, Gao ZG, Yang Y, Zhao BC (2012) Randomized clinical trial of conventional versus cylindrical abdominoperineal resection for locally advanced lower rectal cancer. Am J Surg 204:274–282

    Article  PubMed  Google Scholar 

  • Han JG, Wang ZJ, Qian Q, Dai Y, Zhang ZQ, Yang JS, Li F, Li XB (2014) A prospective multicenter clinical study of extralevator abdominoperineal resection for locally advanced rectal cancer. Dis Colon Rectum 57:1333–1340

    Article  PubMed  Google Scholar 

  • Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  • Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK (1998) The Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899

    Article  CAS  PubMed  Google Scholar 

  • Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94:232–238

    Article  CAS  PubMed  Google Scholar 

  • Huang A, Zhao H, Ling T, Quan Y, Zheng M, Feng B (2014) Oncological superiority of extralevator abdominoperineal resection over conventional abdominoperineal resection: a meta-analysis. Int J Colorectal Dis 29:321–327

    Article  PubMed  Google Scholar 

  • Jänes A, Cengiz Y, Israelsson LA (2004) Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 91:280–282

    Article  PubMed  Google Scholar 

  • Kennelly RP, Rogers AC, Winter DC, Abdominoperineal Excision Study Group (2013) Multicentre study of circumferential margin positivity and outcomes following abdominoperineal excision for rectal cancer. Br J Surg 100:160–166

    Article  CAS  PubMed  Google Scholar 

  • Klein M, Fischer A, Rosenberg J, Gögenur I, Danish Colorectal Cancer Group (DCCG) (2015) Extralevatory abdominoperineal excision (ELAPE) does not result in reduced rate of tumor perforation or rate of positive circumferential resection margin: a nationwide database study. Ann Surg 261:933–938

    Article  PubMed  Google Scholar 

  • Kronberger L (1994) Die geschichtliche Entwicklung der Sphinktererhaltung beim Rektumkarzinom. Acta Chir Austriaca 26:124–126

    Article  Google Scholar 

  • Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 2.1, 2019, AWMF Registrierungsnummer: 021/007OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/. Zugegriffen: 12. Febr. 2019

  • Marr R, Birbeck K, Garvican J, Macklin CP, Tiffin NJ, Parsons WJ, Dixon MF, Mapstone NP, Sebag-Montefiore D, Scott N, Johnston D, Sagar P, Finan P, Quirke P (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242:74–82

    Article  PubMed  PubMed Central  Google Scholar 

  • Martijnse IS, Dudink RL, West NP, Wasowicz D, Nieuwenhuijzen GA, van Lijnschoten I, Martijn H, Lemmens VE, van de Velde CJ, Nagtegaal ID, Quirke P, Rutten HJ (2012) Focus on extralevator perineal dissection in supine position for low rectal cancer has led to better quality of surgery and oncologic outcome. Ann Surg Oncol 19:786–793

    Article  PubMed  Google Scholar 

  • McCall LJ, Cox MR, Wattchow DA (1995) Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Colorectal Dis 10:126–132

    Article  CAS  PubMed  Google Scholar 

  • MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal adenocarcinoma: prospective observational study. BMJ 333:749–782

    Google Scholar 

  • Merkel S, Klossek D, Göhl J, Papadopoulos T, Hohenberger W, Hermanek P (2009) Quality management in rectal carcinoma: what is feasible ? Int J Colorectal Dis 24:931–942

    Article  PubMed  Google Scholar 

  • Messenger DE, Cohen Z, Kirsch R, O’Connor BI, Victor JC, Huang H, McLeod RS (2011) Favorable pathologic and long-term outcomes from the conventional approach to abdominoperineal resection. Dis Colon Rectum 54:793–802

    Article  PubMed  Google Scholar 

  • Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  • Nagtegaal ID, van de Velde CJ, Marijnen GC, van Krieken JHJM, Quirke P (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264

    Article  PubMed  Google Scholar 

  • Nash GM, Weiss A, Dasgupta R, Gonen M, Guillem JG, Wong WD (2010) Close distal margin and rectal cancer recurrence after sphincter-preserving rectal resection. Dis Colon Rectum 53:1365–1373

    Article  PubMed  Google Scholar 

  • Negoi I, Hostiuc S, Paun S, Negoi RI, Beuran M (2016) Extralevator vs. conventional abdominoperineal resection for rectal cancer – a systematic review and meta-analysis. Am J Surg 212:511–526

    Article  PubMed  Google Scholar 

  • Nicholls RJ, Dozois RR (Hrsg) (1997) Surgery of the colon and rectum. Churchill Livingstone, New York, S 458–459

    Google Scholar 

  • Nissan A, Guillem JG, Paty PB, Douglas Wong W, Minsky B, Saltz L, Cohen AM (2001) Abdominoperineal resection for rectal cancer at a specialty center. Dis Colon Rectum 44:27–36

    Article  CAS  PubMed  Google Scholar 

  • Ortiz H, Ciga MA, Armendariz P, Kreisler E, Codina-Cazador A, Gomez-Barbadillo J, Garcia-Granero E, Roig JV, Biondo S, Spanish Rectal Cancer Project (2014) Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer. Br J Surg 101:874–882

    Article  CAS  PubMed  Google Scholar 

  • Palmer G, Anderin C, Martling A, Holm T (2014) Local control and survival after extralevator abdominoperineal excision for locally advanced or low rectal cancer. Colorectal Dis 16:527–532

    Article  CAS  PubMed  Google Scholar 

  • Prytz M, Angenete E, Bock D, Haglind E (2016) Extralevator abdominoperineal excision for low rectal cancer – extensive surgery to be used with discretion based on 3-year local recurrence results: a registry based oberservational national cohort study. Ann Surg 263:516–521

    Article  PubMed  Google Scholar 

  • Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999

    Article  CAS  PubMed  Google Scholar 

  • Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR39 and NCIC-CTG CO16 randomised clinical trial. Lancet 373:821–828

    Article  PubMed  PubMed Central  Google Scholar 

  • Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469

    Article  PubMed  PubMed Central  Google Scholar 

  • Salerno GV, Daniels IR, Moran BJ, Heald RJ, Thomas K, Brown G (2009) Magnetic resonance imaging prediction of an involved surgical resection margin in low rectal cancer. Dis Colon Rectum 52:632–639

    Article  PubMed  Google Scholar 

  • Shen Z, Ye Y, Zhang X, Xie Q, Yin M, Yang X, Jiang K, Liang B, Wang S (2015) Prospective controlled study of the safety and oncological outcomes of ELAPE procure with definitive anatomic landmarks versus conventional APE for lower rectal cancer. Eur J Surg Oncol 41:472–477

    Article  CAS  PubMed  Google Scholar 

  • Shihab OC, Moran BJ, Heald RJ, Quirke P, Brown G (2009) MRI staging of low rectal cancer. Eur Radiol 19:643–650

    Article  PubMed  Google Scholar 

  • Shihab OC, Brown G, Daniels IR, Heald RJ, Quirke P, Moran BJ (2010) Patients with low rectal cancer treated by abdominoperineal excision have worse tumors and higher involved margin rates compared with patients treated by anterior resection. Dis Colon Rectum 53:53–56

    Article  PubMed  Google Scholar 

  • Shihab OC, Heald RJ, Holm T, How PD, Brown G, Quirke P, Moran BJ (2012) A pictorial description of extralevator abdominoperineal excision for low rectal cancer. Colorectal Dis 14:e655–e660

    Article  CAS  PubMed  Google Scholar 

  • Shirouzu K, Ogata Y, Araki Y, Kishimoto Y, Sato Y (2003) A new ultimate anus-preserving operation for extremely low rectal cancer and for anal canal cancer. Tech Coloproctol 7:203–206

    Article  CAS  PubMed  Google Scholar 

  • Stelzner F, Friedrichs N, von Mallek D (2009) Hüllfaszien, Homingareal und Lymphgefäße sind krebsarretierend. Neue MRT-, PET-CT- und klinische Untersuchungen zum kolorektalen Karzinom. Chirurg 80:216–222

    Article  Google Scholar 

  • Stelzner S, Hellmich G, Haroske G, Puffer E, Jackisch T, Witzigmann H (2010) Practicability of quality goals for the treatment of rectal cancer. Int J Colorectal Dis 25:1093–1102

    Article  PubMed  Google Scholar 

  • Stelzner S, Holm T, Moran BJ, Heald RJ, Witzigmann H, Zorenko D, Wedel T (2011a) Deep pelvic anatomy revisited for a description of crucial steps in extra-levator abdominoperineal excision for rectal cancer. Dis Colon Rectum 54:947–957

    Article  PubMed  Google Scholar 

  • Stelzner S, Koehler C, Stelzer J, Sims A, Witzigmann H (2011b) Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer – a systematic overview. Int J Colorectal Dis 26:1227–1240

    Article  PubMed  Google Scholar 

  • Stelzner S, Hellmich G, Sims A, Kittner T, Puffer E, Zimmer J, Bleyl D, Witzigmann H (2016) Long-term outcome of extralevator abdominoperineal excision (ELAPE) for low rectal cancer. Int J Colorectal Dis 31:1729–1737

    Article  PubMed  Google Scholar 

  • Stelzner S, Böttner M, Kneist W, Quirke P, West N, Witzigmann H, Wedel T (2018) Internal anal sphincter nerves – a macroanatomical and microscopic description of the extrinsic autonomic nerve supply of the internal anal sphincter. Colorectal Dis 20:O7–O16

    Article  CAS  PubMed  Google Scholar 

  • Wangensteen OH (1945) Primary resection (closed anastomosis) of rectal ampulla for malignancy with preservation of sphincteric function. Surg Gynecol Obstet 81:1

    Google Scholar 

  • Welsch T, Mategakis V, Contin P, Kulu Y, Büchler MW, Ulrich A (2013) Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications. Int J Colorectal Dis 28:503–510

    Article  PubMed  Google Scholar 

  • Wittekind C, Compton CC, Brierley J, Sobin LH (2012) TNM supplement. A commentary on uniform use, 4. Aufl. Wiley, Chichester

    Google Scholar 

  • Yu HC, Peng H, He XS, Zhao RS (2014) Comparison of short- and long-term outcomes after extralevator abdominoperineal excision and standard abdominoperineal excision for rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 29:183–191

    Article  PubMed  Google Scholar 

  • Zhou X, Sun T, Xie T, Zhang Y, Zheng H, Fu W (2014) Extralevator abdominoperineal excision for low rectal cancer: a systematic review and meta-analysis of the short-term outcome. Colorectal Dis 17:474–481

    Article  Google Scholar 

Download references

Danksagung

Mein ausdrücklicher Dank gilt Herrn Professor Thilo Wedel, Zentrum für Klinische Anatomie, Anatomisches Institut der Christian-Albrechts-Universität zu Kiel, für die gemeinsame Erstellung der anatomischen Präparate, welche im Rahmen des Körperspendeprogrammes der Universität Kiel zur Verfügung gestellt wurden. Der Autor bedankt sich weiterhin bei Herrn Professor Thomas Kittner, Radiologische Klinik des Städtischen Klinikums Dresden, für die freundliche Überlassung der MRT-Bilder und bei Herrn Florian Keller für die Erstellung der Abb. 11.1a.

Author information

Authors and Affiliations

  1. Städtisches Klinikum Dresden, Dresden, Deutschland

    Sigmar Stelzner

Authors
  1. Sigmar Stelzner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sigmar Stelzner .

Editor information

Editors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Campus Benjamin Franklin, Charite – Universitätsmedizin Berlin, Berlin, Germany

    Martin E. Kreis

  2. Klinik für Radiologie Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Patrick Asbach

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Stelzner, S. (2020). Abdominoperineale Rektumexstirpationen. In: Kreis, M., Asbach, P. (eds) MRT-basierte Chirurgie des Rektumkarzinoms. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58159-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-58159-9_11

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-58158-2

  • Online ISBN: 978-3-662-58159-9

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation