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Bedeutung der Endoskopie und Endosonographie für das lokale Staging beim Rektumkarzinom

Impact of endoscopy and endosonography on local staging of rectal carcinoma

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Zusammenfassung

Die Therapieentscheidung zwischen primärer Resektion, neoadjuvanter Therapie und lokaler Exzision hängt beim Rektumkarzinom von einem präzisen lokalen Staging ab. Das lokale Staging beinhaltet dabei die klinische Untersuchung, die starre Rektoskopie und die rektale Endosonographie (EUS). Die digital-rektale Palpation des Tumors ermöglicht eine Graduierung der Mobilität des Tumors, z. B. auf der Schleimhaut oder mit der Rektumwand. Die starre Rektoskopie ermittelt den aboralen Tumorabstand zur Linea dentata bzw. zur Anokutanline. Die rektale Endosonographie ermöglicht die Festlegung des prätherapeutischen UICC-Stadiums durch Evaluation der prätherapeutischen uT- und uN-Kategorie, mit z. T. heterogenen Resultaten. Eine differenzierte Betrachtung der Ergebnisse muss zudem die Wertigkeit der EUS im Vergleich zur Magnetresonanztomographie (MRT) und die Interpretation der Befunde nach neoadjuvanter Therapie einschließen. Darüber hinaus bietet die EUS nur unzureichende Informationen bez. des Tumorabstandes zur zirkumferenziellen Resektionsebene. Technische Verbesserungen, wie die 3D-EUS, sind möglicherweise geeignet, in Zukunft eine Verbesserung des endosonographischen Stagings in diesen Punkten zu liefern.

Abstract

For rectal carcinoma the decision between primary resection, neoadjuvant therapy and local excision depends on an accurate local staging. Local staging includes digital examination, rigid rectoscopy and endorectal ultrasound (EUS). The rectal digitation allows clinical staging according to the mobility of the tumor in relation to the rectal mucosa or the rectal wall. The rigid rectoscopy determines the aboral distance of the tumor from the dentate line or the anal verge. The endorectal ultrasound determines the pre-therapeutic UICC stage on the basis of evaluating the pretherapeutic T and N categories. Results of EUS should be discussed on the background of neoadjuvant therapy including response evaluation and in comparison with the results of magnetic resonance imaging. In addition, there is only little information available concerning evaluation of the circumferential resection margin by EUS. Technical improvements, such as the 3D-EUS, might be appropriate in the future to provide enhancement of EUS staging of rectal tumors.

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  1. Klinik & Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Zentrum Operative Medizin (ZOM), Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    C. Isbert & C.-T. Germer

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Isbert, C., Germer, CT. Bedeutung der Endoskopie und Endosonographie für das lokale Staging beim Rektumkarzinom. Chirurg 83, 430–438 (2012). https://doi.org/10.1007/s00104-011-2203-8

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