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Diagnosis and therapy of rectal cancer

Diagnose und Therapie des Rektumkarzinoms

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Zusammenfassung

GRUNDLAGEN: Das Rektumkarzinom stellt enorme Herausforderungen an die chirurgische Therapie durch den schwierigen Zugang im kleinen Becken mit seiner Nahebeziehung zu funktionell wichtigen Strukturen wie dem Analsphinkter und den autonomen Nerven, die Harnblasen- und Sexualfunktion steuern. Die Behandlung zielt daher sowohl darauf ab die lokalen Heilungsraten zu maximieren wie auch die funktionellen Einbussen der Therapie zu minimieren. METHODIK: Literaturübersicht zur Therapie des Rektumkarzinoms. ERGEBNISSE: Diese Übersicht fokussiert auf den aktuellen Kenntnisstand hinsichtlich Diagnose und Behandlung des Rektumkarzinoms aus einer praktischen Perspektive für ChirurgInnen. Die wichtige Beziehung zwischen genauer lokaler Ausdehnungsbeurteilung und maßgeschneiderter Primärtherapie wird diskutiert. Dies beinhaltet auch die neoadjuvanten multimodalen Strategien. Die Evolution der kurativen Operationstechniken auf Basis embryologischen Verständnisses wird dargestellt, wobei Möglichkeiten und Grenzen der transanalen Exzision wie auch der minimal invasiven Chirurgie aufgezeigt werden. SCHLUSSFOLGERUNGEN: Moderne Diagnoseverfahren und ein besseres Verständnis der Tumorbiologie des Rektumkarzinoms haben zu wesentlichen Fortschritten in der Behandlung geführt. Optimale Chirurgie integriert in ein multimodales Therapiekonzept bleibt zentral wichtig in unseren Bemühungen, die lokale Kontrolle und das Überleben von Patienten mit Rektumkarzinom weiter zu verbessern.

Summary

BACKGROUND: Rectal cancer poses a formidable challenge to surgical treatment due to a technically difficult access in the pelvis with close proximity to functionally important structures such as the anal sphincters and autonomic nerves, which coordinate urinary bladder and sexual functions. Management therefore aims both at maximising local cure rates and minimising functional consequences of treatment. METHODS: Review of the literature on interdisciplinary management of rectal cancer. RESULTS: This review focuses on current evidence regarding diagnosis and treatment of rectal cancer from a practical viewpoint for the surgeon. The important relationship between accurate local staging and tailored primary therapy including neoadjuvant (chemo)radiation strategies is discussed. Evolution of curative operations based on embryological knowledge including possibilities and current limitations of local treatment and minimal access surgery are detailed. A detailed step-by-step description of the surgical technique of rectal resection is presented. CONCLUSIONS: Modern diagnostic tools and better understanding of rectal cancer biology have led to important advances in treatment. Optimal surgery integrated in a multimodality treatment strategy remains central in our attempts to improve local cure rates and survival for patients with rectal cancer.

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Authors and Affiliations

  1. Department of General Surgery, Medical University Vienna, Vienna, Austria

    F. Herbst

  2. Department of Radiotherapy, Medical University Vienna, Vienna, Austria

    J. Widder

  3. Department of Radiodiagnostics, Medical University Vienna, Vienna, Austria

    A. Maier

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  1. F. Herbst
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Correspondence to F. Herbst.

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Herbst, F., Widder, J. & Maier, A. Diagnosis and therapy of rectal cancer. Eur Surg 38, 129–134 (2006). https://doi.org/10.1007/s10353-006-0237-9

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