Zusammenfassung
Die aktuellen S3-Leitlinien zur chirurgischen Therapie des kolorektalen Karzinoms halten fest, dass bei geeigneter Selektion und Expertise des Operateurs laparoskopisch die gleichen onkologischen Ergebnisse wie beim offenen Verfahren erreicht werden können. Dies bedingt, dass an beide Methoden die gleichen Qualitätsanforderungen zu stellen sind. Die wichtigsten Qualitätsparameter der rechtsseitigen (erweiterten) Hemikolektomie sind die tatsächlich zentrale Durchtrennung der versorgenden Arterien (A. ileocolica, rechter Ast der A. colica media bzw. A. colica media selbst) unmittelbar am Abgang des zentralwärtigen Gefäßes (A. mesenterica superior bzw. A. colica media) sowie die scharfe Präparation des Mesokolons ohne jegliche Präparateinrisse. Die Fotodokumentation der frischen Operationspräparate zur Kategorisierung der Präparationsqualität sowie auch zur Bestimmung der Gefäßpedikel erfasst diese Qualitätsparameter und ist zugleich der derzeit beste Surrogatparameter, um hieraus die onkologische Qualität der jeweiligen Operation zu bewerten. Hierbei bestehen nicht nur bei dem laparoskopischen Vorgehen, sondern auch beim offenen Operieren derzeit flächendeckend noch erhebliche Defizite, welche dringend zu beheben sind.
Abstract
The current S3 guidelines on the surgical treatment of colorectal cancer note that with a suitable patient selection and expertise of the surgeon the same oncological results can be achieved laparoscopically as with the open procedure. This requires that the same quality requirements have to be provided for both methods. The most important quality parameters of right sided (extended) hemicolectomy are central ligation of the supplying arteries (ileocolic artery, right branch of the middle colic artery and middle colic artery) flush to the central origin of the vessel (superior mesenteric artery or middle colic artery) and the sharp dissection of the mesocolon without any preparation tears. The photographic documentation of the fresh surgical specimens for categorizing the preparation quality as well as to determine the pedicle of the vessel can capture this quality well and is also currently the best surrogate parameter to evaluate the oncological quality of the operation. At present, there are still considerable widespread deficits not only with the laparoscopic approach but also in open surgery which must be urgently fixed.
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P. Lux, K. Weber und W. Hohenberger geben an, dass kein Interessenkonflikt besteht.
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Dieser Beitrag wurde erstpubliziert in Der Chirurg (2014) 85:593–598.
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Lux, P., Weber, K. & Hohenberger, W. Laparoskopische Chirurgie des Kolonkarzinoms. coloproctology 37, 325–331 (2015). https://doi.org/10.1007/s00053-015-0022-y
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DOI: https://doi.org/10.1007/s00053-015-0022-y
Schlüsselwörter
- Kolorektales Karzinom
- Komplette mesokolische Exzision
- Lymphknotendissektion
- Fotodokumentation
- Qualitätsparameter