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Indikation und Technik der transanal endoskopischen Operation

Transanal endoscopic operation: indications and technique

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Zusammenfassung

Bei der transanal endoskopischen Operation (TEO) handelt es sich um eine spezielle Operationsmethode zur minimal-invasiven Therapie von Rektumtumoren. TEO ist eine Weiterentwicklung bzw. Variante der sog. transanal endoskopischen Mikrochirurgie (TEM), die von G. Bueß entwickelt wurde. Neben gutartigen Tumoren eignet sich diese Operationsmethode für die Resektion sog. Low-risk-T1-Rektumkarzinome, wenn diese aufgrund ihrer Größe und Lokalisation sicher im Gesunden (R0) entfernt werden können. Bei stringenter Patientenselektion werden sehr gute onkologische Ergebnisse erzielt. Entscheidend ist hierbei die endgültige Histologie, sodass die Prozedur primär als erweiterte diagnostische Maßnahme zu werten ist. Beim Vorliegen eines hören Tumorstadiums (> pT1) oder High-risk-Kriterien muss eine sog. Salvage-Operation empfohlen werden. Zahlreiche Studien belegen, dass insbesondere die funktionellen Resultate und die postoperative Lebensqualität nach TEO oder TEM hervorragend sind, zumal als Alternativoperationen die tiefe Rektumresektion bzw. die abdominoperineale Exstirpation zu diskutieren sind, die bekanntermaßen sehr häufig mit funktionellen Defiziten einhergehen.

Abstract

Transanal endoscopic operation (TEO) is a minimally invasive treatment option for certain rectal tumors. The TEO procedure has evolved as a new technique from transanal endoscopic microsurgery (TEM) which was developed by G. Bueß. Apart from the excision of benign lesions this method can also be applied in patients with low-risk T1 carcinoma if size and localization permit complete resection (R0). Using these strict criteria for patient selection one can expect an excellent oncological outcome. However, it must to be stressed that local excision is always part of the diagnostic work-up and that the definitive histology needs to be appreciated. In cases of unfavorable histology (i.e. high risk or higher T stage) radical salvage resection should be performed. Functional results and quality of life are very good following TEO or TEM procedures, especially when comparing the outcome with that of radical rectal resection or abdominoperineal excision.

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Interessenkonflikte

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehung/n hin: Prof. Dr. med. Marco Sailer erhält Unterstützung bei der Ausführung von Kongressen, Symposien und Workshops u. a. von folgenden Firmen: Karl Storz, Covidien, Johnson & Johnson, Falk Foundation, Hitachi Medical, Novartis, Applied Medical. Dr. med. Carsten Möllmann erhält Unterstützung bei der Ausführung von Kongressen, Symposien und Workshops u. a. von folgenden Firmen: Karl Storz, Covidien.

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  1. Klinik für Chirurgie, Bethesda Krankenhaus Bergedorf, Glindersweg 80, 21029, Hamburg, Deutschland

    M. Sailer & C. Möllmann

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  1. M. Sailer
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  2. C. Möllmann
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Correspondence to M. Sailer.

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Sailer, M., Möllmann, C. Indikation und Technik der transanal endoskopischen Operation. Chirurg 83, 1049–1059 (2012). https://doi.org/10.1007/s00104-012-2295-9

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