Lokalrezidive nach Rectumcarcinom — Entstehung, Diagnose, Prognose

Summary

Local recurrences following curative surgery for rectal carcinoma were observed in 167 out of a total of 729 patients (22.9%). The rate of local recurrences was related to the horizontal spread of the tumor (insular/circular, largest tumor diameter), to the macroscopic pattern of growth, and to the Dukes classification. The frequency of local recurrences following anterior and deep anterior resection of the rectum was significantly dependent on the extent of the aboral margin of clearance. Generally speaking, a margin of more than 30 mm is recommended for the anterior and deep anterior resection, measured on the fresh specimen without tension. The rate of local recurrence increases if a local tumor cell dissemination occurs during the operation as a result of an incision through the tumor tissue or an opening of the rectum in the area of the tumor. 90% of the local recurrences were diagnosed within the first two postoperative years. Curative reoperation of local recurrences was possible in 30% (25/82) following anterior and deep anterior resection, but only as an exception (1/74) following abdomino-perineal resection. The age-corrected 5 year survival rate (including postoperative mortality) was 74% for patients without local recurrence, however, only 12% for those with local recurrence. If the local recurrence proved to be operable for cure, a five year survival rate of 33% could still be attained. A reduction of local recurrences can be achieved by careful differentiation of the indications for limited operative procedures (endoscopic polypectomy, local surgical excision, segmental resection), and for anterior resection or abdomino-perineal resection as well as by careful operative technique and especially by avoiding an intraoperative dissemination of tumor cells. With the help of frequent follow-ups, the earliest diagnosis of possible local recurrences should be strived for, in order to allow for curative reoperation.

Zusammenfassung

Nach kurativer Operation von Rectumcarcinomen wurden bei 167 von 729 Patienten (22,9%) Lokalrezidive beobachtet. Die Lokalrezidivrate wird von verschiedenen therapieunabhängigen Faktoren beeinflußt, weiters bei Rectumresektionen von der Weite des aboralen Sicherheitsabstandes sowie von einer etwaigen intraoperativen lokalen Tumorzelldissemination. Die alterskorrigierten 5-Jahres-Überlebensraten (einschließlich postoperativer Letalität) betrugen für Patienten ohne Lokalrezidive 74%, für Patienten mit Lokalrezidiven jedoch nur 12%. Wenn das Lokalrezidiv noch kurativ operabel war, konnte immerhin eine 5-Jahres-Überlebensrate von 33% erzielt werden. Durch engmaschige Nachsorge sollte eine möglichst frühzeitige Diagnose von Lokalrezidiven angestrebt werden, um etwaige Lokalrezidive noch kurativ operieren zu können.