Kolonkarzinom

  • D. Oertli
  • F. Harder

Zusammenfassung

Das Kolonkarzinom gehört zu den häufigsten Malignomen in industrialisierten Ländern. Die meisten Kolonkarzinome treten sporadisch auf. 5–10% der Fälle sind erbliche Risikoerkrankungen (familiäre adenomatöse Polyposis/FAP, hereditäres nichtpolypöses kolorektales Karzinom/HNPCC). Die Diagnosestellung erfolgt durch Koloskopie und Biopsie. Abdomensonographie (Leber!) und Thoraxröntgen gehören zum präoperativen Screening zur Metastasensuche. Orthograde Darmlavage (alternativ intraoperative Darmreinigung, „on table lavage“ bei Notfalleingriffen) und die perioperative Antibiotikaprophylaxe stellen übliche Maßnahmen zur Reduktion septischer Komplikationen dar. Die radikale Entfernung des Kolonkarzinomes erfolgt durch En-bloc-Resektion des tumortragenden Kolonabschnitts mit dem regionären Lymphabflussgebiet ggf. unter Mitresektion infiltrierter umgebender Organe (multiviszerale Resektion). Die Wiederherstellung der Darmkontinuität wird in der Regel durch End-zu-End-Anastomosierung — am besten unter Verwendung einer einreihigen fortlaufenden Handnaht — realisiert. Die Prognose des Kolonkarzinoms wird durch dessen Tumorstadium und durch die Möglichkeit einer vollständigen Resektion beeinflusst. Die Fünfjahresüberlebensraten nach R0-Resektion betragen 70% oder mehr, diejenigen bei R1/R2-Resektion weniger als 10%. Voraussetzungen für die adjuvante Chemotherapie ist eine erfolgte R0-Resektion. Generell wird bei nodal positiven Tumoren (International Union against Cancer/UICC Stadium III) eine Behandlung mit 5-Fluorouracil (5-FU) in Kombination mit Folinsäure empfohlen. Ziele des Tumornachsorgeprogramms sind
  • die frühzeitige Erfassung von Adenomen und eines etwaigen — erneut potenziell kurativ resezierbaren — Tumorrezidivs,

  • die Erkennung und Behandlung postoperativer Folgezustände, d. h. Erhaltung und Optimierung der Lebensqualität, und

  • eine chirurgische Qualitätskontrolle.

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© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • D. Oertli
  • F. Harder

There are no affiliations available

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