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Der Chirurg

, Volume 81, Issue 10, pp 889–896 | Cite as

Lokalrezidiv des Rektumkarzinoms

  • A. TrojaEmail author
  • H.R. Raab
Leitthema

Zusammenfassung

Die Therapie des Rektumkarzinoms hat sich in den letzten Jahrzehnten kontinuierlich weiterentwickelt. Neben Verbesserungen der operativen Technik, wie z. B. der flächendeckenden Durchsetzung der totalen mesorektalen Exzision (TME), haben sich auch (neo-)adjuvante, multimodale Therapiekonzepte weithin etabliert. Durch diese und andere Maßnahmen konnte die Rate an Lokalrezidiven von früher bis zu 50% auf nunmehr unter 10% gesenkt werden. Trotzdem bleibt das lokoregionäre Rezidiv des Rektumkarzinoms eine extreme therapeutische Herausforderung. Bei der Primäroperation sind neben der operativen Expertise des behandelnden Chirurgen vor allem die Lokalisation des Tumors, die zirkumferenziellen Resektionsränder und die Durchführung einer stadiengerechten multimodalen Therapie prädiktiv für das Auftreten eines Lokalrezidivs. Neue molekulargenetische Befunde bestätigen den Verdacht, dass auch die Tumorbiologie ein Risikofaktor für das Auftreten eines Lokalrezidivs ist. Die operative Therapie des Rektumkarzinomrezidivs galt lange Zeit als rein palliative Maßnahme oder wurde hinsichtlich der exenterativen Eingriffe aus mehr emotionalen Gründen als „verstümmelnd“ abgelehnt. Durch ausgedehnte multiviszerale Operationen im Sinne exenterativer Eingriffe im Becken kann es aber heute gelingen, ein 5-Jahres-Überleben von bis zu 30% zu erreichen, wobei allerdings die Mortalität solcher Eingriffe auch in erfahrenen Zentren kaum unter 5% liegt. Damit ist die operative Therapie des Rektumkarzinomrezidivs zwar die mit Abstand beste therapeutische Option im Hinblick auf eine mögliche Kuration, die Ergebnisse können aber noch keinesfalls befriedigen. Zukünftige Entwicklungen müssen die noch weitergehende Rezidivvermeidung, die möglichst frühe Rezidiverkennung und multimodale Konzepte beinhalten.

Schlüsselwörter

Rektumkarzinom Lokalrezidiv Beckenexenteration Risikofaktoren Therapie 

Locally recurrent rectal cancer

Abstract

Over the last decades the therapy of rectal carcinoma has shown continuous improvement. Due to improvements in operative techniques, such as the establishment of total mesorectal excision (TME) and the combination of surgery and (neo-) adjuvant radiochemotherapy, the incidence of locally recurrent rectal cancer could be improved from nearly 50% to less then 10%. Nevertheless recurrent rectal carcinoma remains a severe problem. Predictive factors relating to locally recurrent rectal cancer are surgical experience, localization of the tumor, circumferential resection margins, stage-oriented multimodal therapy and a suitable oncological procedure for the primary tumor. In addition the tumor-specific biology also seems to be a relevant risk factor for recurrence. Operative treatment of locally recurrent rectal cancer was seen for a long time as a palliative procedure. Newer data show that resection of locally recurrent rectal cancer can be carried out with a curative intention in experienced institutions with a long-term 5 year survival of about 30% and mortality around 5%. The composite sacropelvic resection technique is a reasonable option in the curative treatment of locally recurrent rectal cancer. For the future the focus must be on improvements in the primary therapy of rectal carcinoma to avoid local recurrence. In addition early diagnosis of local recurrence and multimodal therapies will be of decisive importance.

Keywords

Rectal cancer Local recurrence Sacropelvic resection Risk factor Therapy 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Klinik für Allgemein- und ViszeralchirurgieKlinikum Oldenburg GmbHOldenburgDeutschland

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