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Spätpostoperative Komplikationen und Folgezustände nach Rektumresektion

Prävention, Erkennung, Therapie

Late complications and functional disorders after rectal resection

Prevention, detection and therapy

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Zusammenfassung

Mit der erfolgreichen Umsetzung multimodaler Therapiekonzepte und der Verbesserung der chirurgischen Technik wurde die Prognose der Patienten mit Rektumkarzinom verbessert. Aus diesem Grund werden langfristige Spätkomplikationen und Folgezustände, welche die postoperative Lebensqualität nach onkologischer Rektumresektion bestimmen, zunehmend wahrgenommen. Insgesamt spielen bei der Manifestation verschiedener Probleme im Langzeitverlauf sowohl direkte Folgen des Operationstraumas als auch Nebenwirkungen der multimodalen Therapie eine wichtige Rolle. In diesem Zusammenhang ist in den vergangenen Jahren das anteriore Resektionssyndrom „low anterior resection syndrome“ (LARS) als klinisches Mischbild funktioneller Störungen bekannt geworden. Dieses wird von verschiedenen Determinanten beeinflusst und kann durch die neoadjuvante Bestrahlung aggraviert werden. Störungen der Blasen- und Sexualfunktion sowie benigne Stenosen im Bereich der Anastomose sind davon unabhängige Probleme. Therapien solcher Spätkomplikationen und Folgezustände sind insgesamt schlecht validiert oder nicht vorhanden. Für funktionelle Störungen werden Maßnahmen wie Biofeedback, Beckenbodentraining und bei ausbleibendem Erfolg die Sakralnervenstimulation vorgeschlagen. Für Anastomosenstenosen stehen interventionelle und operative Verfahren zur Verfügung. Aus der aktuellen Datenlage wird jedoch klar, dass durch eine adäquate chirurgische Technik ein Großteil der Spätkomplikationen und Folgezustände reduziert werden kann.

Abstract

The prognosis of patients with rectal carcinoma has been improved with the implementation of multimodal therapy and improvement of the surgical technique. Therefore, late complications and functional consequences that determine the quality of life following oncological rectal resection are increasingly being recognized. In general both the surgical trauma and side effects of the multimodal therapy play a critical role in the manifestation of various problems in the long-term course after treatment of rectal carcinoma. In this context the low anterior resection syndrome (LARS) has been described which is influenced by different factors and can be worsened by neoadjuvant radiation. Disorders of the urinary bladder and sexual dysfunction as well as benign anastomotic stenoses are problems independent of LARS. Therapeutic approaches for these late complications and functional disorders have either been insufficiently evaluated or are not available. Treatment of functional disorders can be attempted by pelvic floor training, biofeedback and sacral nerve stimulation. Interventional and surgical procedures are available to treat anastomotic stenosis. It must be emphasized that an adequate surgical technique is indispensable to avoid most of these late complications and functional disorders.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Reibetanz, M. Kim, C.-T. Germer und N. Schlegel geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland

    J. Reibetanz, M. Kim, C.-T. Germer & N. Schlegel

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  1. J. Reibetanz
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  2. M. Kim
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  3. C.-T. Germer
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Reibetanz, J., Kim, M., Germer, CT. et al. Spätpostoperative Komplikationen und Folgezustände nach Rektumresektion. Chirurg 86, 326–331 (2015). https://doi.org/10.1007/s00104-014-2851-6

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  • DOI: https://doi.org/10.1007/s00104-014-2851-6

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