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Indikationen und Techniken der endoskopisch-mikrochirurgischen transanalen Tumorexzision

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Moderne Chirurgie des Rektumkarzinoms

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Zusammenfassung

Die totale mesorektale Exzision (TME) stellt, insbesondere bei fortgeschrittenen Tumoren, ggf. in Kombination mit der neoadjuvanten Radiochemotherapie, unverändert den Goldstandard in der Therapie des Rektumkarzinoms dar. Eine Sonderrolle hingegen stellen frühe Tumore bzw. T-Kategorien und Adenome dar, die kein oder nur ein geringes Risiko zur lymphogenen Metastasierung aufweisen. Unter Berücksichtigung der Mortalität nach konventionellen Resektionen und Kalkulierung des erhöhten Rezidivrisikos nach lokaler Exzision (LE) kann für diese frühen Rektumkarzinome erwogen werden, von einer systematischen Lymphknotendissektion und damit von einem radikalchiurgischen Vorgehen abzusehen. Auch ist zu berücksichtigen, dass durch eine adäquate TME und mesenteriale Lymphknotendissektion zwar unter Mitnahmen der Filterstationen das lymphogene Ausbreitungs- und damit das lokoregionäre Rezidivrisisko beeinflusst werden, das Risiko zur systemischen Metastasierung kann hierdurch jedoch wahrscheinlich nicht beeinflusst werden.

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Authors and Affiliations

  1. Fachbereich Chirurgie und Koloproktologie, Kompetenz- und Referenzzentrum für Koloproktologie, Aukammallee 33, 65191, Wiesbaden, Deutschland

    Thomas Borschitz PD Dr. med.

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  1. Thomas Borschitz PD Dr. med.
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Correspondence to Thomas Borschitz PD Dr. med. .

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Editors and Affiliations

  1. Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Martin E. Kreis

  2. Klinik für Allgemein- und Viszeralchirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Germany

    Joachim Straßburg

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Borschitz, T. (2015). Indikationen und Techniken der endoskopisch-mikrochirurgischen transanalen Tumorexzision. In: Kreis, M., Straßburg, J. (eds) Moderne Chirurgie des Rektumkarzinoms. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40390-3_7

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  • DOI: https://doi.org/10.1007/978-3-642-40390-3_7

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