Zusammenfassung
Anamnese, klinische Untersuchung mit rektal-digitaler Palpation, die starre Rektoskopie mit Biopsie, die Koloskopie zum Ausschluss einer Zweitneoplasie, Endosonographie und Computertomographie/MRT des Abdomens und des Beckens sowie eine Röntgenaufnahme der Thoraxorgane ermöglichen ein zuverlässiges klinisches Staging in der überwiegenden Mehrzahl der Patienten mit Rektumkarzinom.
Anhand dieser Untersuchungsmethoden wird das Therapieziel Palliation oder Kuration definiert und zumeist eine Entscheidung möglich, ob der Patient durch ein lokales Exzisionsverfahren, ein transabdominelles Resektionsverfahren oder eine abdominoperineale Rektumexstirpation kurativ therapiert werden kann oder nur palliative Maßnahmen sinnvoll sind. Die Indikation zu einer präoperativen Radiochemotherapie ist auf dem Boden des präoperativen Stagings zu stellen und dem Patienten zu vermitteln, ebenso wie eine eventuelle multiviszerale Resektion bis hin zur Exenteration bei ausgedehntem Tumor oder die gleichzeitige Resektion von Lebermetastasen. Nur die Kombination von optimalem Staging, interdisziplinärer Therapiestrategie und chirurgische Expertise führen für jeden Patienten unabhängig vom Tumorstadium zum bestmöglichen Ergebnis.
Abstract
Patient history, clinical examination including digital rectal examination, rectoscopy with biopsy, colonoscopy for exclusion of secondary neoplasms, and endoscopic ultrasound, CT-scan or MRT of the abdomen and pelvis together with chest x-ray are necessary for a reliable staging in the vast majority of patients with rectal cancer.
The thorough evaluation helps to define the therapeutic aim, either curative resection by local excision, resection or extirpation of the rectum or only palliative treatment. The possible advantages of a preoperative radiochemotherapy have to be discussed with the patient based on pretreatment staging, as well as the possible need for multivisceral resections, simultaneous or staged liver resection and pelvic exenteration in advanced tumors. Only the combination of optimal staging, interdisciplinary therapeutic strategies and experienced surgical performance guarantee optimal results for any patient in every tumor stage.
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Jauch, KW., Iesalnieks, I., Kreis, M.E. et al. Prätherapeutische Diagnostik und operative Therapiestrategien beim Rektumkarzinom. Onkologe 11, 814–821 (2005). https://doi.org/10.1007/s00761-005-0946-x
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DOI: https://doi.org/10.1007/s00761-005-0946-x