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Operative Strategien bei hereditären kolorektalen Karzinomen

Surgical strategies for hereditary colorectal cancer

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Zusammenfassung

Das hereditäre kolorektale Karzinom (KRK) repräsentiert eine große diagnostische und therapeutische Herausforderung. Neben den üblichen diagnostischen Methoden kommt der Familienanamnese sowie der histologischen Sicherung und Mutationsanalyse diesbezüglich eine herausragende Rolle zu. Gelingt anhand von Klinik, Anamnese und Histologie die Diagnose und Einordnung eines hereditären Karzinoms, wird je nach zugrunde liegender Form die weitere Therapie festgelegt. Während bei einer familiären adenomatösen Polyposis (FAP) immer eine Koloproktomukosektomie nach Abschluss der Pubertät empfohlen wird, reicht die Therapieempfehlung bei anderen Formen (attenuierter FAP [aFAP], MUTYH-assoziierte adenomatöse Polypose [MAP], hereditäres nichtpolypöses kolorektales Karzinom [HNPCC]/Lynch-Syndrom) je nach klinischer Präsentation von engmaschiger endoskopischer Kontrolle über onkologische Resektion bis hin zur Kolektomie. Allgemein gilt, dass die Behandlung hereditärer KRK eine individuelle Herangehensweise erfordert und eine enge interdisziplinäre Zusammenarbeit notwendig ist. Wird eine Operation durchgeführt, so sollte prinzipiell ein minimal-invasives Vorgehen bevorzugt werden, einzelne Studien konnten hierzu bereits einen potenziellen Nutzen der robotischen Chirurgie gegenüber der Laparoskopie herausarbeiten.

Abstract

Hereditary colorectal cancer (hCRC) represents a major diagnostic and therapeutic challenge. In addition to the usual diagnostic methods, the family history, histological confirmation and mutation analysis play an important role in identifying the type of hereditary CRC. The diagnosis and classification of hCRC are carried out based on the anamnesis, clinical presentation and histology and the further treatment is determined depending on the underlying type of hCRC. For familial adenomatous polyposis (FAP) coloproctomucosectomy after the end of puberty is always recommended, whereas the treatment recommendations for other forms, such as attenuated FAP (aFAP), MUTYH-associated polyposis (MAP) and hereditary nonpolyposis colon cancer (HNPCC, Lynch syndrome), range from close surveillance and endoscopic control, through segmental resection up to colectomy. Irrespective of the type of hCRC, the treatment regimens necessitate an individualized approach and require close interdisciplinary cooperation. When colorectal resection is performed, minimally invasive procedures should principally be prioritized and some studies could demonstrate a potential benefit of robotic surgery compared to laparoscopy.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    M. Kelm, A. Wiegering, C.-T. Germer &  S. Flemming

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  1. M. Kelm
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  2. A. Wiegering
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  3. C.-T. Germer
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  4. S. Flemming
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Correspondence to S. Flemming.

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M. Kelm, A. Wiegering, C.-T. Germer und S. Flemming geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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C.-T. Germer, Würzburg

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Kelm, M., Wiegering, A., Germer, CT. et al. Operative Strategien bei hereditären kolorektalen Karzinomen. Chirurgie 94, 412–416 (2023). https://doi.org/10.1007/s00104-023-01823-y

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