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Nachsorge beim kolorektalen Karzinom

Follow-up for colorectal carcinomas. A critical balance of 14-years follow-up

Eine kritische Bilanz aus 14 Jahren Tumornachsorge

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Coloproctology Aims and scope

Zusammenfassung

Seit 1981 wird in Lübeck Nachsorge beim kolorektalen Karzinom prospektiv durchgeführt, seit 1987 mit stadienadaptierten Programmen. Von 98% der zwischen 1979 und 1990 (präadjuvanter Zeitraum) kurativ resezierten Patienten liegen Verlaufsbeobachtungen bis Dezember 1996 vor. 36% aller Patienten entwickelten ein erneutes Tumorwachstum mit Lokalrezidiven. Fernmetastasen, Zweitkarzinomen oder multiplen Tumormanifestationen. In der univariaten Auswertung ergaben sich hochsignifikante Überlebenszeitverlängerungen für 1. regelmäßig nachgesorgte Patienten, 2. asymptomatische Patienten, 3. Patienten mit normalem CEA-Wert zum Zeitpunkt des Tumorrückfalls, 4. kurativ reoperierte Patienten, 5. palliative chirurgische Therapie gegenüber anderen palliativen Behandlungsformen. Ohne Einfluß auf die Prognose war, wer die Untersuchungen durchführte (Hausarzt/Klinik). Die Kosten für die Nachsorge betrugen zwischen 1979 und 1995 1,3 Millionen DM ohne Verwaltungs- und Koordinationskosten, was pro „geheilten” Patienten (Tumorfreiheit fünf Jahre nach Reoperation) etwa 30 000 DM beträgt.

Abstract

In a prospective study regular follow-up for colorectal cancer has been performed in Lübeck since 1981. Since 1987 different programmes allowed to differentiate between high- and low-risk patients. Until December 1996 we investigated 98% of the patients who have been curatively resected between 1979 and 1990 (period before adjuvant therapy). Recurrences (local, distant, metachronous tumors or multilocular) were found in 36%. There was a significantly higher survival rate in patients with 1. intensive follow-up, 2. asymptomatic patients, 3. patients with a normal CEA level at recurrence, 4. patients with curative reoperation, 5. among the different palliative therapies surgical intervention. Patients followed-up in the hospital had no significantly higher survival rates compared to follow-up by general practitioners. Follow-up costs between 1979 and 1995 were 1.3 millions DM, for each “cured” patient (5-year recurrence-free survival after reoperation) about 30 000 DM.

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Authors and Affiliations

  1. Klinik für Chirurgie, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, D-23538, Lübeck

    Elisabeth Oevermann, Thomas Schiedeck, Claudia Killaitis & Hans -Peter Bruch

  2. Stiftung Deutsche Klinik für Diagnostik GmbH, Deutschland

    Alexander Herold

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  1. Elisabeth Oevermann
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  2. Alexander Herold
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  3. Thomas Schiedeck
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  4. Claudia Killaitis
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  5. Hans -Peter Bruch
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Oevermann, E., Herold, A., Schiedeck, T. et al. Nachsorge beim kolorektalen Karzinom. Coloproctol 21, 84–92 (1999). https://doi.org/10.1007/BF03044656

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