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Komplette mesokolische Exzision

Gibt es genügend Evidenz?

Complete mesocolic excision

Is there enough evidence?

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Nach wie vor stellt die primäre Resektion die Standardtherapie des nichtmetastasierten Kolonkarzinoms dar. Analog zum weltweit anerkannten Konzept der totalen mesorektalen Exzision („total mesorectal excision“, TME) für das Rektumkarzinom wurde für das Kolonkarzinom das Konzept der kompletten mesokolischen Exzision („complete mesocolic excision“, CME) vorgestellt, welches die Entfernung des jeweils onkologisch relevanten Mesokolons unter Respektierung der Integrität des Mesokolons sowie die zentrale vaskuläre Ligatur (CVL) mit radikaler Lymphknotendissektion beinhaltet. Die aktuelle Datenlage zur CME zeigt mit starker Evidenz, dass die Präparate nach CME-Resektionen bessere histopathologische Qualitätskriterien (inkl. einer höheren Anzahl an resezierten Lymphknoten und einer höheren Dissektionsrate in der korrekten mesokolischen Schicht) aufweisen als jene nach konventioneller, nicht den Prinzipien der CME folgenden Kolonresektion. Allerdings besteht bisher aufgrund einer teils heterogenen Studienlage und Schwächen der bisherigen Studien (fehlende Subgruppenanalysen nach Lokalisation des Karzinoms, Vergleich mit historischen Kollektiven und enorme Divergenz in der chirurgischen Ausführung der konventionellen Kolonresektionen) eine noch limitierte Evidenz für das onkologische Ergebnis und den Vergleich zwischen offener und laparoskopischer CME. Weitere Studien zum onkologischen Outcome sind notwendig, um der CME für Kolonkarzinome den gleichen Stellenwert wie der TME für Rektumkarzinome zuschreiben zu können.

Abstract

Standard therapy of nonmetastatic colon cancer is primary resection. Similar to the worldwide accepted concept of total mesorectal excision (TME) for rectal cancer, the concept of complete mesocolic excision (CME) was introduced for colon cancer and consists of resection of the mesocolon while respecting the integrity of the mesocolon as well as central vascular ligation (CVL) with radical lymph node dissection. Current data on CME shows strong evidence that specimens from CME resections have better histopathological quality criteria, including a higher number of resected lymph nodes and a higher dissection rate in the correct mesocolic plane than those after “conventional” colon resection. However, due to partly heterogeneous study results and weaknesses of previous studies (lack of subgroup analysis, comparison with historical collectives and enormous divergence in conventional colon resections), there is limited evidence for the oncological outcome and the comparison between open and laparoscopic CME. Further studies on oncological outcome after CME are needed in order that CME colon resection for colon cancer achieve the same status as TME rectal resection for rectal cancer.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum der Friedrich-Alexander-Universität, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    M. Brunner, M. Maak, K. E. Matzel, A. Denz, K. Weber &  R. Grützmann MBA

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  1. M. Brunner
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  2. M. Maak
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  3. K. E. Matzel
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  6. R. Grützmann MBA
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Correspondence to R. Grützmann MBA.

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Interessenkonflikt

M. Brunner, M. Maak, K.E. Matzel, A. Denz, K. Weber und R. Grützmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Brunner, M., Maak, M., Matzel, K.E. et al. Komplette mesokolische Exzision. coloproctology 40, 8–14 (2018). https://doi.org/10.1007/s00053-017-0219-3

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