Zusammenfassung
GRUNDLAGEN: Unklar ist, wie das Rektumkarzinom chirurgisch therapiert werden soll: offen oder minimal invasiv, und wie neoadjuvante Konzepte implementiert werden sollen. METHODIK: Analyse der Literatur zum chirurgischen Management des Rektumkarzinoms. ERGEBNISSE: Onkologische Kriterien werden offen und laparoskopisch gleichermaßen erfüllt (Resektionsgrenzen, Lymphknotenresektion), wenn die Eingriffe in erfahrenen Zentren durchgeführt werden. Aufgrund der Beckenanatomie scheint das offene Vorgehen bei tiefen Rektumkarzinomen vorteilhaft. Die totale mesorektale Resektion sollte für wirklich tiefe Rektumkarzinome verwendet werden, höher gelegene Tumore sind ausreichend mit einer subtotalen mesorektalen Resektion zu behandeln. SCHLUSSFOLGERUNGEN: In den meisten Fällen kann das Rektumkarzinom laparoskopisch reseziert werden. Entsprechende Erfahrung ist notwendig, um die Ergebnisse von sogenannten "high volume centers" zu reproduzieren.
Summary
BACKGROUND: Discrepancy exists how to surgically approach rectal cancer (open or minimally invasive) and how to implement neoadjuvant oncological concepts into the treatment algorithm. METHODS: Analysis of the literature regarding the surgical treatment of rectal cancer. RESULTS: Oncological criteria (resection margin and lymphnode harvest) are equally met by the laparoscopic and open approach, when conducted in experienced centers. Due to the pelvic anatomy, the open approach seems to be advantageous for low rectal cancers, when compared to laparocopy. Total mesorectal excision should be reserved for low rectal cancers, tumors of the mid and proximal portion of the rectum should be treated by subtotal mesorectal excision. CONCLUSIONS: Laparoscopic rectal surgery can replace the open approach in the majority of the cases. Respective expertise is required to reproduce the excellent results of high volume centers.
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References
Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003;237:335–42
Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E. Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 2009;250:54–61
Shihab OC, Heald RJ, Rullier E, Brown G, Holm T, Quirke P, Moran BJ. Defining the surgical planes on MRI improves surgery for cancer of the low rectum. Lancet Oncol 2009;10:1207–11
Heald RJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence. Br J Surg 1982;69:613–6
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457–60
Martling AL, Holm T, Rutquist LE, et al. Effect of a surgical training programme on the outcome of rectal cancer in the County of Stockholm. Lancet 2000;356:93–6
Wibe A, Møller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, Langmark F, Myrvold HE, Søreide O; Norwegian Rectal Cancer Group. A national strategic change in treatment policy for rectal cancer – implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002;45:857–66
Påhlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjödahl R, Öjerskog B, Damber L, Johansson R. The Swedish Rectal Cancer Registry. Br J Surg 2007;94:1285–92
Pezim ME, Nicholls RJ. Survival after high or low ligation of the inferior mesenteric artery during curative surgery for rectal cancer. Ann Surg 1984;200:729–33
Grinnell RS. Results of ligation of the inferior mesenteric artery at the aorta in resection of carcinoma of the descending and sigmoid colon and rectum. Surg Gynecol Obstet 1965;120:1031
Langevin JM, Rothenberger DA, Goldberg SM. Accidental splenic injury during surgical treatment of the colon and rectum. Surg Gynecol Obstet 1984;159:139–44
Grinnell RS. Distal intramural spread of carcinoma of the rectum and rectosigmoid. Surg Gynecol Obstet 1954;99:421–9
Umpleby HC, Fermor B, Symes MO, Williamson RCN. Viability of exfoliated colorectal carcinoma cells. Br J Surg 1984;71:659–63
Moran BJ, Docherty A, Finnis D. Novel stapling technique to facilitate low anterior resection for rectal cancer. Br J Surg 1994;81:1230
Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and coloanal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8
Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal cancer. Br J Surg 1986;73:139–41
Hallböök O, Påhlman L, Krog M, Wexner SD, Sjödahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996;224:58–65
Heriot AG, Tekkis PP, Constantinides V, Paraskevas P, Nicholls RJ, Darzi A, Fazio VW. Meta-analysis of colonic reservoirs versus straight coloanal anastomisis after anterior resection. Br J Surg 2006;93:19–32
Machado M, Hygren J, Goldman S, Ljungqvist O. Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer – aprospective randomized trial. Ann Surg 2003;238:214–20
Lazorthes F, Chiotasso P, Gamagami RA, Istvan G, Chevreau P. Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight colorectal anastomosis. Br J Surg 1997;84:1449–51
Hida J, Ysutomi M, Fujimoto K, et al. Functional oucome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size. Dis Colon Rectum 1996;39:986–91
Z'graggen K, Maurer CA, Birrer S, et al. A new surgical concept for rectal replacement after low anterior resection: transverse coloplasty pouch. Ann Surg 2001;234:780–5
von Flüe M, Harder F. A new technique for pouch-anal recontruction after total mesorectal excision. Dis Colon Rectum 1994;37:1160–2
Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Fürst A, Celebrezze J Jr, Galanduik S, Orangio G, Hyman N, Bokey L, Tiret E, Kirchdorfer B, Medich D, Tietze M, Hull T, Hammel J. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 2007;246:481–8
Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R; the RECTODES study group. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer – a randomised multicenter trial. Ann Surg 2007;246:207–14
West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P. Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 2008;26:3517–22
Hojo K, Sawada T, Moriya Y. An analysis of survival and voiding, sexual function after wide ileopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenecteomy. Dis Colon Rectum 1989;32:128–33
Bretagnol F, Rullier E, Laurent C, Zerbib F, Gontier R, Saric J. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum 2004;47:832–8
Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, Tiret E. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 2007;246:916–21
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Påhlman, L., Krivocapic, Z. Surgery for rectal cancer (conventional open surgery). Eur Surg 42, 267–275 (2010). https://doi.org/10.1007/s10353-010-0569-3
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DOI: https://doi.org/10.1007/s10353-010-0569-3