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Der Chirurg

pp 1–11 | Cite as

Evidenzbasierte Chirurgie des Rektumkarzinoms

  • M. GradeEmail author
  • H. Flebbe
  • B. M. Ghadimi
Leitthema

Zusammenfassung

In den letzten vier Jahrzehnten hat sich die Therapie des Rektumkarzinoms grundlegend verändert und so zu einer deutlichen Prognoseverbesserung geführt. Maßgebliche Meilensteine waren hier die Einführung der totalen mesorektalen Exzision und die Implementierung multimodaler Therapiestrategien. Komplementiert wurden diese Fortschritte durch die konsequente Umsetzung einer standardisierten histopathologischen Aufarbeitung des chirurgischen Resektates sowie die Einführung einer hochauflösenden MRT-Diagnostik. Zudem wurden neue Operationsverfahren eingeführt wie die laparoskopische und kürzlich auch die robotische Rektumresektion. Weitere technische Neuerungen umfassen beispielsweise das pelvine Neuromonitoring oder die Fluoreszenzbildgebung. Ziel dieser Übersichtsarbeit ist es, die Evidenz für ausgewählte, zum Teil kontrovers diskutierte Prinzipien der chirurgischen Therapie des Rektumkarzinoms zu evaluieren.

Schlüsselwörter

Minimalinvasive Rektumchirurgie Primäre Chirurgie Neoadjuvante Therapie Abdominoperineale Exstirpation Watch-and-wait-Strategie 

Evidence-based surgery of rectal cancer

Abstract

Over the past four decades, the treatment algorithms for rectal cancer have fundamentally changed, which resulted in a considerable improvement of oncological outcomes. In this context, the surgical concept of total mesorectal excision and the implementation of multimodal treatment strategies represent key milestones. These improvements were complemented by a standardized histopathological work-up of the surgical specimen and the introduction of high-resolution magnetic resonance imaging (MRI) diagnostics. In addition, novel surgical techniques have been introduced, such as laparoscopic and robotic rectal resection. Other technological innovations include intraoperative pelvic neuromonitoring and fluorescence imaging. This review highlights the current evidence for selected, sometimes controversially discussed principles of surgical treatment strategies in rectal cancer.

Keywords

Minimally invasive rectal surgery Primary surgery Neoadjuvant treatment Abdominoperineal extirpation Watch-and-wait strategy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Grade, H. Flebbe und B.M. Ghadimi geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral- und KinderchirurgieUniversitätsmedizin GöttingenGöttingenDeutschland

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