Zusammenfassung
Die primäre Therapie des Analkarzinoms ist die kurative Radiochemotherapie. Nach Diagnosesicherung besteht die Rolle des Chirurgen in der Behandlung von lokalen Komplikationen durch Sicherung der Stuhlpassage und Protektion des Perineums durch die laparoskopischen Anlage eines künstlichen Darmausganges. Bei Patienten mit Tumorpersistenz oder -rezidiv nach Radiochemotherapie kann durch die chirurgische Salvage-Therapie im Sinne einer abdominoperinealen Rektumexstirpation eine deutliche Besserung der onkologischen Prognose erzielt werden. Diese geht jedoch mit einer hohen Morbidität von bis zu 80% einher, zu der insbesondere Wundheilungsstörungen im Bereich des Perineums beitragen. Deswegen sollen primär myokutane Lappenplastiken zur Deckung der perinealen Resektionshöhle verwendet werden, wodurch die Rate an Wundheilungsstörungen substanziell gesenkt werden kann.
Abstract
The primary therapy of anal cancer is curative radiochemotherapy. Following a confirmed diagnosis the role of the surgeon is the treatment of local complications of anal cancer by securing bowel passage and protection of the perineum by laparoscopic placement of a preternatural anus or stoma. For patients with a persistent or recurrent tumor following radiochemotherapy a clear improvement in the oncological process can be achieved by surgical salvage therapy using an abdominoperineal rectum extirpation. However, this is accompanied by a high morbidity of up to 80%. Of particular importance here are disturbances in wound healing in the perineum; therefore, a primary myocutaneous flap surgery can be used to cover the perineal resection wound and the rate of disturbances in wound healing can be substantially reduced.
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Rijcken, E., Senninger, N. Chirurgische Therapie des Analkarzinoms. Onkologe 18, 692–698 (2012). https://doi.org/10.1007/s00761-012-2265-3
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DOI: https://doi.org/10.1007/s00761-012-2265-3