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Intraoperative lokale Tumorzelldissemination in der Rektumkarzinomchirurgie

Einfluss von Operationsprinzipien und neoadjuvanter Therapie

Intra-operative local tumor cell dissemination in rectal carcinoma surgery

Effect of operation principles and neoadjuvant therapy

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Zusammenfassung

Hintergrund

Der Einfluss von Operationsprinzipien und neoadjuvanter Therapie auf die Häufigkeit einer intraoperativen lokalen Tumorzelldissemination (LTZD) in der Rektumkarzinomchirurgie und deren Folgen bez. Lokalrezidiv- und Überlebensraten wurden untersucht.

Patienten und Methoden

Das Krankengut des Erlanger Registers kolorektaler Karzinome (ERCRC) von 1969 bis 2008 wurde analysiert und die Ergebnisse mit der Literatur verglichen.

Ergebnisse

Im ERCRC betrug die Häufigkeit einer LTZD 6,7% (n=2764), im Schrifttum 1980 bis 2008 6,9% (n=13.395). Seit Einführung der totalen mesorektalen Exzisions (TME)-Chirurgie wurde eine LTZD signifikant seltener beobachtet. Eine neoadjuvante Therapie beeinflusst die Häufigkeit einer LTZD nicht. Nach LTZD steigt die Lokalrezidivrate signifikant an, die 5-Jahres-Überlebensrate sinkt signifikant. Dies gilt auch für neoadjuvant vorbehandelte Patienten.

Schlussfolgerung

Auch in der heutigen Ära der TME-Chirurgie ist der Vermeidung einer LTZD Aufmerksamkeit zu widmen. Das Vorkommen einer LTZD ist obligat zu dokumentieren und im Rahmen der laufenden Qualitätssicherung zu erfassen. Bei nicht vorbestrahlten Patienten ist im Falle einer LTZD eine postoperative Radiochemotherapie indiziert.

Abstract

Background

The influence of surgical principles and neoadjuvant therapy on the frequency of local tumor cell dissemination (LTCD) in rectal carcinoma surgery and its consequences for local recurrence and survival rates were analyzed.

Patients and methods

Data from the Erlangen registry for colorectal carcinomas (ERCRC) from 1969–2008 were compared with data from the literature published in 1980–2008.

Results

LTCD was observed in 6.7% in the ERCRC (n=2764) and a frequency of 6.9% was reported in in the literature (n=13,395). In the course of time and especially since the introduction of total mesorectal excision (TME) surgery, the incidence of LTCD has significantly decreased. Neoadjuvant treatment did not influence the frequency of LTCD. Following LTCD the rate of local recurrence significantly increased and the 5 year survival rate significantly decreased. This also applied to patients with neoadjuvant therapy.

Conclusions

Even in the era of TME surgery attention must to be paid to avoidance of LTCD. It is obligatory to document the occurrence of LTCD and it must be taken into consideration in routine quality assurance. In cases of LTCD postoperative chemoradiation is indicated for patients without neoadjuvant irradiation.

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  1. Chirurgische Klinik, Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    S. Merkel, W. Hohenberger & P. Hermanek

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Merkel, S., Hohenberger, W. & Hermanek, P. Intraoperative lokale Tumorzelldissemination in der Rektumkarzinomchirurgie. Chirurg 81, 719–727 (2010). https://doi.org/10.1007/s00104-010-1919-1

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