Skip to main content

Advertisement

SpringerLink
Log in

Multiviszerale und Standardresektionen bei kolorektalen Karzinomen

Multivisceral and standard resections in colorectal cancer

  • Standorte
  • Published:
coloproctology Aims and scope

Zusammenfassung

Fragestellung und Hintergrund

Ziel dieser aktuellen Studie ist die Bestimmung der prognostischen Faktoren für das Langzeitüberleben bei Patienten mit fortgeschrittenen kolorektalen Karzinomen in einer konsekutiven Kohorte.

Patienten und Methodik

Zwischen 1. Januar 2002 und 31. Dezember 2008 wurden insgesamt 123 Patienten wegen eines kolorektalen T4-Karzinoms in der Chirurgischen Klinik UK-SH Campus Lübeck operiert.

Ergebnisse

Insgesamt 78 Patienten hatten eine multiviszerale Resektion (MVR). Die postoperative Morbidität war in der Patientengruppe mit MVR (34,6% vs. 26,7%) erhöht. Gleichwohl fanden wir bezüglich der 30-Tage-Mortalität keine signifikanten Unterschiede (7,7% vs. 8,9%; p=0,815). Der hauptsächliche prognostische Faktor, der in der Multivarianzanalyse Signifikanz erreichte, war die Möglichkeit einer R0-Resektion (p<0,0001), die in einer 5-Jahres-Überlebensrate von 55% bei Patienten mit kurativer Resektion resultierte. Es gab keine statistisch signifikanten Unterschiede im 5-Jahres-Überleben zwischen multiviszeralen und nichtmultiviszeralen Resektionen (p=0,608). Auch konnten wir keine signifikanten Unterschiede bei Kolon- oder Rektumkarzinomen (p=0,839) finden. Zwischen laparoskopischen und offenen Eingriffen (p=0,610) sowie zwischen geplanten und Notoperationen gab es ebenfalls keine signifikanten Unterschiede (p=0,674). Darüber hinaus war die Existenz von Lymphknotenmetastasen kein prädiktiver Faktor hinsichtlich des Überlebens, da es keine Unterschiede zwischen Patienten mit und ohne Lymphknotenmetastasen gab (p=0,658).

Schlussfolgerung

Multiviszerale Resektionen sind mit dem gleichen 5-Jahres-Überleben assoziiert wie die Standardresektionen. Daher sollte die Absicht, eine R0-Resektion durchzuführen, immer das Hauptziel bei Eingriffen wegen kolorektaler Karzinome sein. Bei geplanten Operationen ist in bestimmten Fällen ein laparoskopischer Ansatz gerechtfertigt.

Abstract

Purpose

The current study was designed to identify prognostic factors for long-term survival in patients with advanced colorectal cancer in a consecutive cohort.

Methods

A total of 123 patients were operated because of T4 colorectal cancer between 1 January 2002 and 31 December 2008 in the Clinic of Surgery, UK-SH Campus Luebeck.

Results

A total of 78 patients underwent a multivisceral resection. The postoperative morbidity was elevated in the patient group with multivisceral resections (34.6% vs. 26.7%). Nevertheless, we detected no significant differences concerning 30 days mortality (7.7% vs. 8.9%; p=0.815). The main prognostic factor that reached significance in the multivariate analysis was the possibility to obtain a R0 resection (p<0.0001) resulting in a 5-year survival rate of 55% for patients with curative resection. There were no statistically significant differences in 5-year survival between multivisceral and non-multivisceral resections (p=0.608). Also we were not able to detect any significant differences for cancer of colonic or rectal origin (p=0.839), for laparoscopic vs. open procedures (p=0.610), and for emergency vs. planned operations (p=0.674). Moreover, the existence of lymph node metastases was not a predictive factor concerning survival as there was no difference between patients with and without lymph node metastases (p=0.658).

Conclusions

Multivisceral resections are associated with the same 5-year survival as standard resections. Therefore, the aim to perform a R0 resection should always be the main goal in surgery for colorectal cancer. In planned operations, a laparoscopic approach is justified in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Brenner H, Bouvier AM, Foschi R et al (2011) Progress in colorectal cancer survival in Europe, from the late 1980s to the early 21st century: The EUROCARE study. Int J Cancer doi:10.1002/ijc.26192

    Google Scholar 

  2. Gebhardt C, Meyer W, Ruckriegel S, Meier U (1999) Multivisceral resection of advanced colorectal carcinoma. Langenbecks Arch Surg 384:194–199

    Article  PubMed  CAS  Google Scholar 

  3. Lehnert T, Methner M, Pollok A et al (2002) Multivisceral resection for locally advanced primary colon and rectal cancer. An analysis of prognostic factors in 201 patients. Ann Surg 235:217–225

    Article  PubMed  Google Scholar 

  4. Nakafusa Y, Tanaka T, Tanaka M et al (2004) Comparison of multivisceral resection and standard operation for locally advanced colorectal cancer: analysis of prognostic factors for short-term and long-term outcome. Dis Colon Rectum 47:2055–2063

    Article  PubMed  Google Scholar 

  5. Croner RS, Merkel S, Papadopoulos T et al (2009) Multivisceral resection for colon carcinoma. Dis Colon Rectum 52(8):1381–1386

    Article  PubMed  Google Scholar 

  6. Eisenberg SB, Kraybill WG, Lopez MJ (1990) Long-term results of surgical resection of locally advanced colorectal cancer. Surgery 108:779–786

    PubMed  CAS  Google Scholar 

  7. Hermanek P (1999) Prognostic factor research in oncology. J Clin Epidemiol 52:371–374

    Article  PubMed  CAS  Google Scholar 

  8. Radespiel-Troeger M, Hohenberger W, Reingruber B (2004) Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratification. Cancer 958–967

  9. Tsai HL, Lu CY, Hsieh JS et al (2007) The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg 11(5):660–665

    Article  PubMed  Google Scholar 

  10. Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 11(7):733–739

    Article  PubMed  CAS  Google Scholar 

  11. Hunter JA, Ryan JA, Schultz P (1987) En bloc resection of colon cancer adherent to other organs. Am J Surg 145:67–71

    Google Scholar 

  12. Gall FP, Tonak J, Altendorf A (1987) Multivisceral resections in colorectal cancer. Dis Colon Rectum 30:337–341

    Article  PubMed  CAS  Google Scholar 

  13. Kruschewski M, Pohlen U, Hotz HG et al (2006) Results of multivisceral resection of primary colorectal cancer. Zentralbl Chir 131:217–222

    Article  PubMed  CAS  Google Scholar 

  14. Bokey EL, Chapuis PH, Fung C (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–487

    Article  PubMed  CAS  Google Scholar 

  15. Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 89:1557–1562

    Google Scholar 

  16. Merkel S, Meyer C, Papadopoulos T et al (2007) Urgent surgery in colon carcinoma. Zentralbl Chir 132:16–25

    Article  PubMed  CAS  Google Scholar 

  17. Andreoni B, Chiappa A, Bertani E et al (2007) Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients. World J Surg Oncol 5:73

    Article  PubMed  Google Scholar 

  18. Darakhshan A, Lin BPFC, Chan C et al (2008) Correlates and outcomes of tumor adherence in resected colonic and rectal cancers. Ann Surg 247:650–658

    Article  PubMed  Google Scholar 

  19. Kuhry E, Schwenk WF, Gaupset R et al (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2:CD003432

    PubMed  Google Scholar 

  20. Bretagnol F, Dedieu A, Zappa M et al (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13(2):138–143

    Article  PubMed  CAS  Google Scholar 

  21. Hemandas AK, Abdelrahman T, Flashman KG et al (2010) Laparoscopic colorectal surgery produces better outcomes for high risk cancer patients compared to open surgery. Ann Surg 252(1):84–89

    Article  PubMed  Google Scholar 

  22. Hoffmann M, Phillips C, Oevermann E et al (2012) Multivisceral and standard resections in colorectal cancer. Langenbecks Arch Surg 397:75-8

    Article  PubMed  Google Scholar 

Download references

Interessenskonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Chirurgische Klinik, Universitätsklinik Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Hoffmann, C. Phillips, E. Oevermann, C. Killaitis, U.-J. Roblick, P. Hildebrand, C.G. Buerk, H. Wolken, P. Kujath, E. Schloericke & H.-P. Bruch

Authors
  1. M. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Oevermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Killaitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U.-J. Roblick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Hildebrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C.G. Buerk
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Wolken
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P. Kujath
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. E. Schloericke
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. H.-P. Bruch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Hoffmann.

Additional information

Herrn Prof. Dr. med. Hans-Peter Bruch zum 65. Geburtstag gewidmet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoffmann, M., Phillips, C., Oevermann, E. et al. Multiviszerale und Standardresektionen bei kolorektalen Karzinomen. coloproctology 34, 177–185 (2012). https://doi.org/10.1007/s00053-012-0288-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00053-012-0288-2

Schlüsselwörter

Keywords

Search

Navigation