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Surgery of colon cancer (conventional open and laparoscopic surgery)

Chirurgische Therapie des Kolonkarzinoms (konventionell offenes und laparoskopisches Vorgehen)

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Zusammenfassung

GRUNDLAGEN: Das Kolonkarzinom ist eine der häufigsten Todesursachen in der westlichen Hemisphäre mit ca. 639.000 krebsbezogenen Todesfällen pro Jahr weltweit. Die radikale chirurgische Tumorentfernung ist die entscheidende Behandlungsoption und stellt ein klassisches Betätigungsfeld des Allgemein- und Viszeralchirurgen dar. METHODIK: Ziel der vorliegenden Arbeit war mit Hilfe einer Literatursuche in PubMed, DIMDI und EMBASE ergänzt durch eigene klinische Erfahrungen wichtige Arbeiten zur chirurgischen Therapie im Sinne einer aktuellen Übersichtsarbeit zusammenzufassen und dabei auch theoretische Grundlagen zu vermitteln. ERGEBNISSE: Tumorsitz und entsprechende Lymphabflusswege, Respektierung von anatomisch-embryonalen Schichten und arterielle Perfusion an den Absetzungsrändern bestimmen das Resektionsausmaß. Eine an diesen Prinzipien orientierte optimale chirurgische Technik ermöglicht eine niedrige Lokalrezidivrate und wirkt sich positiv auf das Langzeitergebnis aus. Die laparoskopische Technik ist dabei der offenen Technik ebenbürtig. Auch in der Metastasenchirurgie ermöglicht die R0 Resektion ein Langzeitüberleben für ausgewählte Patienten. Durch multimodale Rehabilitation im Sinne eines perioperativen Fast Tack Managements lässt sich das chirurgische Trauma reduzieren und die Rekonvaleszenz beschleunigen. SCHLUSSFOLGERUNGEN: Resektabilität und chirurgische Technik sind entscheidend für das Überleben von Patienten mit lokalisiertem oder bereits metastasiertem Kolonkarzinom.

Summary

BACKGROUND: Colon cancer is a leading cause of death in western countries and accounts for 639,000 cancer-related deaths worldwide. Surgical tumour clearance is the key treatment option and represents a classic field of action for the general and visceral surgeon. METHODS: PubMed, EMBASE and DIMDI were searched for articles referring to state of the art surgical management of colon cancer complemented by our own clinical experience to create an overview of up-to-date treatment options and theoretical background knowledge. RESULTS: The extent of bowel and mesenteric resection is dictated by the vascular supply and corresponding lymphatic drainage, careful attention to anatomical-embryological tissue planes and provision of adequate blood supply at the resection margins. Accordingly, optimal surgical clearance results in low local recurrence rates and translates into improved survival. In this context, the open and laparoscopic approaches yield similar results in terms of long-term outcome and oncological radicality. Radical resection of metastases results in long-term survival in selected patients. Fast Track rehabilitation facilitates attenuation of perioperative stress response and enhances recovery. CONCLUSION: Resectability and surgical technique are pivotal for long-term survival in all stages of colon cancer.

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  1. Department of General, Visceral and Transplant Surgery, Klinikum Augsburg, Augsburg, Germany

    H. Spatz & M. Anthuber

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  1. H. Spatz
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  2. M. Anthuber
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Correspondence to H. Spatz.

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Spatz, H., Anthuber, M. Surgery of colon cancer (conventional open and laparoscopic surgery). Eur Surg 42, 260–266 (2010). https://doi.org/10.1007/s10353-010-0572-8

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  • DOI: https://doi.org/10.1007/s10353-010-0572-8

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