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Laparoskopische komplette mesokolische Exzision

Wo liegen die Schwierigkeiten?

Laparoscopic complete mesocolic excision

What are the pitfalls?

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Hintergrund

Die Einführung der kompletten mesokolischen Exzision (CME) diente analog der totalen mesorektalen Exzision (TME) beim Rektumkarzinom der Verbesserung der onkologischen Ergebnisse, insbesondere bei rechtsseitigen Kolonkarzinomen mit schlechter Prognose. Durch Anwendung einer sicheren und präzisen CME-Technik hat der Chirurg einen erheblichen prognostischen Einfluss. In der jüngeren Vergangenheit fand vermehrt die laparoskopische Technik breitere Verwendung.

Ziel der Arbeit

Ist die laparoskopische CME im Vergleich zum offenen Vorgehen ein vergleichbar sicheres Verfahren, und worin liegen die Schwierigkeiten?

Material und Methode

Die aktuelle Literatur wurde ausgewertet. Operationsschritte und ihre Schwierigkeiten werden dargestellt.

Ergebnisse

Die laparoskopische CME erzielt vergleichbare Ergebnisse zur offenen CME. Insgesamt weist die CME höhere Komplikationsraten gegenüber der Nicht-CME auf, die durch die Laparoskopie jedoch gesenkt werden können. Im Vergleich zur Nicht-CME gehen beide Verfahren mit einer längeren Operationszeit, höherem Blutverlust sowie einer höheren Komplikationsrate einher. Durch die CME-Technik kann das Outcome verbessert werden.

Diskussion

Die laparoskopische CME ist eine chirurgisch anspruchsvolle Operation, die einer Lernkurve bedarf, um die Vorteile der Laparoskopie und geringe Komplikationsraten zu gewährleisten. Durch die Eingliederung einer strukturierten laparoskopischen Ausbildung in minimal-invasiver Chirurgie und Fortbildungen können höhenwertige Präparatqualitäten und damit ein besseres Outcome erreicht werden.

Abstract

Background

Complete mesocolic excision (CME), which is analogous to total mesocolic excision (TME) of the rectum, was introduced by Hohenberger in 2009. CME of the right hemicolon significantly improves oncological patients’ outcome. Using a safe and precise CME technique, the surgeon has a significant prognostic effect on the outcome. In recent years, laparoscopic techniques for CME have become more widely used.

Aim of the study

Is laparoscopic CME as safe as the open procedure and, furthermore, are there pitfalls with respect to the technique?

Materials and methods

The current literature was analyzed. The surgical steps and their difficulties are presented.

Results

Laparoscopic CME has outcomes similar to the conventional procedure. Overall, CME is associated with significantly more side effects compared to non-CME. However, laparoscopic CME approaches have lowered the complication rates significantly. Compared to non-CME, both procedures are associated with longer operation times, higher blood loss, and higher complication rates. The CME procedure can significantly improve the outcome.

Discussion

Laparoscopic CME is a demanding and challenging technique that has a steep learning curve in order to achieve the benefits and lower complication rates of laparoscopic surgery. By implementing structured laparoscopic training in minimally invasive surgery and allowing for regular continued education, the quality of surgical preparation and hence the patients’ outcome can be enhanced significantly.

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Authors and Affiliations

  1. Klinik für Allgemeine, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller Str. 3, 24159, Kiel, Deutschland

    B. Reichert, H. Aselmann, C. Schafmayer & T. Becker

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  1. B. Reichert
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  2. H. Aselmann
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  3. C. Schafmayer
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  4. T. Becker
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Correspondence to B. Reichert.

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Interessenkonflikt

B. Reichert, H. Aselmann, C. Schafmayer und T. Becker geben an, dass kein Interessenkonflikt besteht.

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

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Reichert, B., Aselmann, H., Schafmayer, C. et al. Laparoskopische komplette mesokolische Exzision. coloproctology 40, 24–30 (2018). https://doi.org/10.1007/s00053-017-0220-x

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