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Rektale neuroendokrine Tumoren: chirurgische Therapie

Rectal neuroendocrine tumors: surgical therapy

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Zusammenfassung

Die rektalen neuroendokrinen Tumoren (NET) zeigen eine steigende Inzidenz in den letzten Jahren. Die meisten Tumoren sind asymptomatisch und werden im Rahmen von Vorsorgekoloskopien diagnostiziert. Da weniger als 1 % der Tumoren Serotonin produzieren, werden sie fast nie durch ein Karzinoidsyndrom entdeckt. In den Leitlinien der europäischen (ENETS) und nordamerikanischen Fachgesellschaften (NANETS) finden sich für die Kliniker, die diese Tumoren selbst in Zentren nur selten sehen, nützliche Diagnose- und Behandlungsalgorithmen. Grundlage für die Therapie sind die Tumorgröße und histopathologische Risikofaktoren für eine (Lymphknoten-)Metastasierung. Bei den < 1 cm, gut differenzierten rektalen NET wird die lokale Exzision endoskopisch oder chirurgisch empfohlen. Die Neoplasien mit einer Größe von 1–2 cm stellen eine prognostische und therapeutische Grauzone dar. Ab einer Größe von 1,5 cm muss eine onkologisch radikale Resektion als anteriore Rektumresektion oder abdominoperineale Exstirpation mit TME (totale mesorektale Exzision) erfolgen. Resektable Leber- und Lungenmetastasen gut differenzierter NET sollen in kurativer Intention chirurgisch angegangen werden.

Abstract

The incidence of rectal neuroendocrine tumors (NET) has increased in recent years. Most of these neoplasms are asymptomatic and are diagnosed by colonoscopy screening, which could be one of the reasons for the increasing occurrence. As less than 1 % of rectal NET produce serotonin they are practically never discovered due to a carcinoid syndrome. The current guidelines of the European (ENETS) and North American (NANETS) Neuroendocrine Tumor Societies support clinicians with useful diagnostic and treatment algorithms. The most important criteria for therapy are tumor size and histopathological risk factors for metastases. For well-differentiated rectal neuroendocrine neoplasms < 1 cm, local endoscopic or surgical excision is recommended. Due to the lack of evidence tumors sized 1–2 cm represent a grey area for prognosis and treatment. All NET > 1.5 cm must be excised by radical surgery as low anterior rectal resection or abdominoperineal extirpation with total mesorectal excision (TME). Resectable liver and lung metastases of well-differentiated NETs should be surgically treated with curative intent.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Deutschland

    O. Radulova-Mauersberger, S. Stelzner &  H. Witzigmannn

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  1. O. Radulova-Mauersberger
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Correspondence to H. Witzigmannn.

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O. Radulova-Mauersberger, S. Stelzner und H. Witzigmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Radulova-Mauersberger, O., Stelzner, S. & Witzigmannn, H. Rektale neuroendokrine Tumoren: chirurgische Therapie. Chirurg 87, 292–297 (2016). https://doi.org/10.1007/s00104-016-0153-x

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