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Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

Colorectal adenoma: pro conventional/laparoscopic resection

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Zusammenfassung

Die Kenntnis darüber, dass Adenome über die Adenom-Karzinom-Sequenz früher oder später in einem bösartigen Tumor enden, erfordert die vollständige Entfernung kolorektaler Polypen. Deren Abtragung erfolgt in den meisten Fällen endoskopisch. Die Indikation zum operativen Vorgehen ergibt sich nur bei unvollständiger Abtragung, ungünstiger anatomischer Lage oder schon makroskopischem Malignomverdacht, wenn sich der Befund beim Unterspritzen nicht ausreichend abheben lässt. Sollte ein chirurgisches Vorgehen erforderlich sein, können bei ausreichend vorhandener Expertise auch minimal-invasive Verfahren zur Anwendung kommen.

Malignitätsverdächtige Adenome im mittleren und unteren Rektumdrittel sollten nicht zeitaufwendig und umständlich durch endoskopische Submukosadissektion abgetragen werden. Diese lassen sich transanal (konventionell oder durch transanale endoskopische Mikrochirurgie) chirurgisch schnell und sicher en bloc im Sinne einer Vollwandresektion resezieren, ermöglichen damit eine genaue pathologische Beurteilung hinsichtlich der Invasionstiefe und des zirkumferenziellen Resektionsrands und nur in High-risk-Konstellationen ist eine zusätzlich radikal-chirurgische Maßnahme erforderlich.

Abstract

The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.

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  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    S. Rüth, J. Spatz & M. Anthuber

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  1. S. Rüth
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  2. J. Spatz
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  3. M. Anthuber
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Rüth, S., Spatz, J. & Anthuber, M. Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion. Chirurg 82, 520–525 (2011). https://doi.org/10.1007/s00104-010-2062-8

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