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Evidenzbasierte Chirurgie des Rektumkarzinoms

Evidence-based surgery of rectal cancer

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Zusammenfassung

In den letzten vier Jahrzehnten hat sich die Therapie des Rektumkarzinoms grundlegend verändert und so zu einer deutlichen Prognoseverbesserung geführt. Maßgebliche Meilensteine waren hier die Einführung der totalen mesorektalen Exzision und die Implementierung multimodaler Therapiestrategien. Komplementiert wurden diese Fortschritte durch die konsequente Umsetzung einer standardisierten histopathologischen Aufarbeitung des chirurgischen Resektates sowie die Einführung einer hochauflösenden MRT-Diagnostik. Zudem wurden neue Operationsverfahren eingeführt wie die laparoskopische und kürzlich auch die robotische Rektumresektion. Weitere technische Neuerungen umfassen beispielsweise das pelvine Neuromonitoring oder die Fluoreszenzbildgebung. Ziel dieser Übersichtsarbeit ist es, die Evidenz für ausgewählte, zum Teil kontrovers diskutierte Prinzipien der chirurgischen Therapie des Rektumkarzinoms zu evaluieren.

Abstract

Over the past four decades, the treatment algorithms for rectal cancer have fundamentally changed, which resulted in a considerable improvement of oncological outcomes. In this context, the surgical concept of total mesorectal excision and the implementation of multimodal treatment strategies represent key milestones. These improvements were complemented by a standardized histopathological work-up of the surgical specimen and the introduction of high-resolution magnetic resonance imaging (MRI) diagnostics. In addition, novel surgical techniques have been introduced, such as laparoscopic and robotic rectal resection. Other technological innovations include intraoperative pelvic neuromonitoring and fluorescence imaging. This review highlights the current evidence for selected, sometimes controversially discussed principles of surgical treatment strategies in rectal cancer.

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  1. Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    M. Grade,  H. Flebbe &  B. M. Ghadimi

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Grade, M., Flebbe, H. & Ghadimi, B.M. Evidenzbasierte Chirurgie des Rektumkarzinoms. Chirurg 90, 387–397 (2019). https://doi.org/10.1007/s00104-019-0802-y

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