Zusammenfassung
GRUNDLAGEN: Die laparoskopische kolorektale Chirurgie in der Therapie benigner Erkrankungen ist zunehmend akzeptiert und etwa in der Behandlung der chronisch rezidivierenden Divertikulitis bereits Standard. METHODIK: Die Daten der letzten Jahre zeigen deutlich, dass das laparoskopische Vorgehen beim linksseitigen Kolonkarzinom der offenen Technik unter onkologischen Gesichtspunkten gleichwertig ist. Darüber hinaus sind mit dem laparoskopischen Vorgehen verschiedene Vorteile wie reduziertes Zugangstrauma, geringere pulmonale Komplikationen und geringere Immunosuppression verbunden, die konsekutiv in schnellerer Rekonvaleszenz und verkürztem Krankenhausaufenthalt münden. ERGEBNISSE: Dennoch wird das laparoskopische Vorgehen zur Therapie des Rektumkarzinoms kontrovers diskutiert. Es bestehen immer noch Zweifel an der onkologischen Radikalität bzw. Gleichwertigkeit gegenüber dem offenen Vorgehen. Die Beantwortung der Frage nach sicherer Schonung des autonomen Nervenplexus bzw. der Integrität des dissezierten Mesorektums scheint unbeantwortet – und dies insbesondere unter der Vorstellung der engen anatomischen Gegebenheiten des männlichen Beckens eines übergewichtigen Patienten. SCHLUSSFOLGERUNGEN: Die klinische Realität und nicht zuletzt die Daten mehrerer Studien zeigen jedoch, dass laparoskopische Rektumchirurgie onkologisch adäquat machbar ist, und auch die Lymphknotendissektion bzw. die TME gleichwertig dem offenen Vorgehen durchführbar scheint.
Summary
BACKGROUND: Laparoscopic colorectal procedures for the treatment of benign disorders are increasingly appreciated and have become the standard procedure for e.g. surgical treatment for recurrent diverticulitis. METHODS: Data show that even laparoscopic surgery for left sided colon cancer is seen as oncologically equal to the classic open resection. Laparoscopic resections offer several benefits e.g. minimal impairment of gastrointestinal and pulmonary functions, lower immunosuppression, shorter hospital stay, and faster reconvalescence. RESULTS: However, laparoscopic resections for rectal cancer are still discussed controversially as concerns are raised in terms of oncologic radicality, port-site metastases, autonomic nerve preservation, and completeness of total mesorectal excision especially in obese male patients with a tight pelvis. CONCLUSIONS: The clinical reality and several studies demonstrate that laparoscopic rectal surgery for cancer is oncologically feasible, lymph node dissection is equivalent to open surgery, and the incidence of port-site recurrence is not increased compared to wound recurrence in conventional laparotomy.
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Roblick, U., Bader, F., Jungbluth, T. et al. Laparoscopic resection for rectal cancer. Eur Surg 42, 276–282 (2010). https://doi.org/10.1007/s10353-010-0580-8
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DOI: https://doi.org/10.1007/s10353-010-0580-8