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Der Chirurg

, Volume 76, Issue 12, pp 1135–1144 | Cite as

Prophylaktische Chirurgie beim hereditären nichtpolypösen kolorektalen Karzinom

  • G. Möslein
  • C. Ohmann
  • M. Wenzel
Leitthema

Zusammenfassung

Das häufigste kolorektale Prädispositionssyndrom ist das Lynch-Syndrom, auch HNPCC („hereditary nonpolyposis colorectal cancer“) genannt. Die Option einer prophylaktischen Chirurgie hängt von der Penetranz des genetischen Defektes und der Heterogenität der Krankheitsausprägung ab. Da bei HNPCC 20% der Mutationsträger nie ein Karzinom ausbilden, ist eine rein prophylaktische Dickdarmresektion nicht indiziert. Bei Auftreten eines kolorektalen Karzinoms hingegen ergibt sich die Frage nach einem Benefit durch Erweiterung der onkologischen Resektion im Sinne einer totalen Kolektomie bzw. einer (restaurativen) Proktokolektomie. Diese Patienten sollten in eine von der Krebshilfe geförderten prospektiv-randomisierten Studie eingebracht werden (http://www.hnpcc-studie.de). Auch für das Endometrium und den Magen wird bei hoher Karzinominzidenz und unsicherer Vorsorge die Option einer prophylaktischen Intervention diskutiert.

Schlüsselwörter

Lynch-Syndrom HNPCC Prophylaktische Chirurgie Kolorektales Karzinom Endometriumkarzinom Magenkarzinom 

Prophylactic surgery for hereditary nonpolyposis colorectal cancer

Abstract

The most frequent hereditary colorectal cancer predisposition is Lynch syndrome, or hereditary nonpolyposis colorectal cancer. The option of prophylactic surgery relies on the penetrance of the genetic defect and the heterogeneity of the condition. Since 20% of all mutation carriers never move on to develop cancer, the purely prophylactic setting is not indicated. However, when colorectal cancer is diagnosed, the question arises if the patient may benefit from extended surgery — total colectomy or (restorative) proctocolectomy. These patients should be entered into the ongoing prospective-randomized study by German Cancer Aid (http://www.hnpcc-studie.de). Due to substantially increased cancer risk and poor surveillance options, the endometrium and stomach are also subject to the question of prophylactic intervention.

Keywords

Lynch’s syndrome Hereditary nonpolyposis colorectal cancer Prophylactic surgery Colorectal cancer Endometrial cancer Gastric cancer 

Notes

Interessenkonflikt:

Keine Angaben

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Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Allgemein- und Viszeralchirurgie, ColoproktologieSt. Josefs Hospital Bochum-Linden
  2. 2.Koordinierungszentrum für Klinische Studien (KKS)Universitätsklinikum Düsseldorf
  3. 3.Allgemein- und Viszeralchirurgie, ColoproktologieSt. Josefs Hospital Bochum-LindenBochum

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