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Der Onkologe

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Rezidivresektionen beim Rektumkarzinom

  • I. Gockel
  • C. Pommer
  • S. Langer
  • B. Jansen-Winkeln
CME
  • 26 Downloads

Zusammenfassung

Zur kurativen Behandlung des lokal rezidivierenden Rektumkarzinoms (LRRC) ist eine vollständige Resektion mit mikroskopisch tumorfreien Rändern (R0) erforderlich. Für das präoperative Staging der lokalen und systemischen Erkrankungen sind bildgebende Untersuchungen von zentraler Bedeutung. Aufgrund verbesserter Operationsstrategien und -techniken können heute Rezidive entfernt werden, die noch vor einigen Jahren als inoperabel galten. In mehreren Studien wurden mit hohen Sakrektomien vertretbare onkologische Ergebnisse erzielt. Zu den neueren Operationstechniken gehören die „high subcortical sacrectomy“ (HiSS), die erweiterte laterale Resektion und die „extended lateral pelvic sidewall excision“ (ELSiE). Zur Rekonstruktion stehen biologische Meshs, myokutane Lappen sowie Titanmaterialien oder Knochenallotransplantate zur Verfügung. In spezialisierten Zentren können ein effizientes Komplikationsmanagement und eine Nachbehandlung angeboten werden.

Schlüsselwörter

Präoperatives Staging Rezidivklassifikation High subcortical sacrectomy (HiSS) Extended lateral pelvic sidewall excision (ELSiE) Plastische Rekonstruktion 

Resection of recurrent rectal cancer

Abstract

A curative treatment of locally recurrent rectal cancer (LRRC) can only be achieved with a complete resection and microscopically tumor-free surgical margins (R0). Imaging techniques are the most important investigations for the preoperative staging of local and systemic diseases. Due to substantial improvements in surgical strategies and techniques, previously unresectable tumors can now be excised. Several publications have demonstrated the oncological benefits of high sacral resection for LRRC. High subcortical sacrectomy (HiSS), extended lateral resection and extended lateral pelvic sidewall excision (ELSiE) belong to the newer surgical options. Biological meshes, various myocutaneous flaps, titanium and bone allografts can be used for reconstruction. Specialized centers provide an efficient management of complications and postoperative treatment.

Keywords

Preoperative staging Recurrence classification  High subcortical sacrectomy (HiSS) Extended lateral pelvic sidewall excision (ELSiE) Plastic reconstruction 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

I. Gockel, C. Pommer, S. Langer und B. Jansen-Winkeln 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 2018

Authors and Affiliations

  • I. Gockel
    • 1
  • C. Pommer
    • 1
  • S. Langer
    • 2
  • B. Jansen-Winkeln
    • 1
  1. 1.Klinik für Viszeral‑, Transplantations‑, Thorax‑ und GefäßchirurgieUniversitätsklinikum Leipzig, AöRLeipzigDeutschland
  2. 2.Klinik für Orthopädie, Unfall- und Plastische ChirurgieUniversitätsklinikum Leipzig, AöRLeipzigDeutschland

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