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Kolonkarzinom

  • J.-P. Ritz
  • H. J. Buhr

Zusammenfassung

Das Kolonkarzinom gehört zu den häufigsten Malignomen in industrialisierten Ländern und tritt in der Regel sporadisch auf. Nur 5–10% der Fälle sind erbliche Risikoerkrankungen (familiäre adenomatöse Polyposis/FAP, hereditäres nichtpolypöses kolorektales Karzinom/HNPCC). Die Diagnosestellung erfolgt durch Kolonoskopie und Biopsie. Abdomensonographie (Leber) und Thorax-Röntgenuntersuchung gehören im präoperativen Screening zur Metastasensuche. Die perioperative Antibiotikaprophylaxe stellt eine Maßnahme zur Reduktion septischer Komplikationen dar. Auf eine orthograde Darmlavage und den Einsatz von Drainagen kann häufig verzichtet werden. Die radikale Entfernung des Kolonkarzinoms erfolgt durch En-bloc-Resektion des tumortragenden Kolonabschnitts mit radikulärer Gefäßligatur und Mitnahme des regionären Lymphabflussgebiet ggf. unter Mitresektion infiltrierter umgebender Organe (multiviszerale Resektion). Die Wiederherstellung der Darmkontinuität wird in der Regel durch End-zu-End-Anastomosierung realisiert. Die Prognose des Kolonkarzinoms wird durch das Tumorstadium und die Möglichkeit einer vollständigen R0-Resektion beeinflusst. Die 5-Jahres-Überlebensraten nach R0-Resektion betragen 70% oder mehr, diejenigen bei R1/R2-Resektion weniger als 10%.

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Literatur

  1. Ahmadi a, Polyak S, Draganov P (2009) Colorectal cancer surveillance in inflammatory bowel disease: the search continues. World J Gastroenterol 15: 61–66CrossRefPubMedGoogle Scholar
  2. Aly EH (2009) Laparoscopic colorectal surgery — summary of the current evidence. Ann R Coll Surg Engl 91: 541–544CrossRefPubMedGoogle Scholar
  3. Bingham SA et al. (2003) Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study. Lancet 361: 1496–1501CrossRefPubMedGoogle Scholar
  4. Brady M, Kinn S, Stuart P (2004) Preoperative fasting for adults to prevent perioperative complications (Cochrane Review). In: The Cochrane Library, Issue 3. John Wiley & Sons, ChichesterGoogle Scholar
  5. Brown SR, Goodfellow PB (2005) Transverse versus midline incision for abdominal surgery. Cochrane Database Syst Rev CD 005199Google Scholar
  6. Collins PD, Mpofu C, Watson AJ, Rhodes JM (2006) Strategies for detecting colon cancer and/or dysplasia in patients with inflammatory bowel disease. Cochrane Database Syst Rev 2006:CD000279Google Scholar
  7. Dekovich AA (2009) Endoscopic treatment of colonic obstruction. Curr Opinion Gastroenterol 25: 50–54CrossRefGoogle Scholar
  8. Evans RC, Fear S, Ashby D et al. (2002) Diet and colorectal cancer: an investigation of the lectin/galactose hypothesis. Gastroenterology 122: 1784–1792CrossRefPubMedGoogle Scholar
  9. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in europe in 2006. Angaben der WHO Mortality Database 2009; www.who.intGoogle Scholar
  10. Gill S, Blackstock AW, Goldberg RM (2007) Colorectal cancer. Mayo Clin Proc 82: 114–129CrossRefPubMedGoogle Scholar
  11. Grantcharov TP, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167: 260–267CrossRefPubMedGoogle Scholar
  12. Gul YA, Lian LH, Jabar FM, Moissinac K (2002) Antibiotic prophylaxis in elective colorectal surgery. ANZ J Surg 72:275–878CrossRefPubMedGoogle Scholar
  13. Halle M et al. (2009) Körperliche Aktivität in der Prävention und Therapie des kolorektalen Karzinoms. Dtsch Ärztebl 106: 722–727Google Scholar
  14. Hardcastle JD, Chamberlain JO, Robinson MHE et al. (1996) Randomized controlled trial of fecal occult blood screening for colorectal cancer. Lancet 348: 1472–1477CrossRefPubMedGoogle Scholar
  15. Harris GJC, Church JM, Senagore AJ et al. (2002) Factors affecting local recurrence of colonic adenocarcinoma. Dis Colon Rectum 45:1029–1034CrossRefPubMedGoogle Scholar
  16. Haynes AB et al. (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. New Engl J Med 360: 491–499CrossRefPubMedGoogle Scholar
  17. Hermanek P, Mansmann U, Staimmer DS, Riedl S (2000) The German experience: the surgeon as a prognostic factor in colon and rectal cancer surgery. Surg Oncol Clin North Am 9:33–49Google Scholar
  18. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation — technical notes and outcome. Colorectal Dis 11: 354–364CrossRefPubMedGoogle Scholar
  19. Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87: 1480–1493CrossRefPubMedGoogle Scholar
  20. Jass JR (2006) Colorectal cancer: a multipathway disease. Crit Rec Oncog 12: 273–287Google Scholar
  21. Jorgensen OD, Kronberg O, Fenger C (2002) A randomised study of screening for colorectal cancer using the fecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 50: 29–32CrossRefPubMedGoogle Scholar
  22. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183: 630–641CrossRefPubMedGoogle Scholar
  23. Killingback M, Barron P, Dent O (2002) Elective resection and anastomosis for colorectal cancer: A prospective audit of mortality and morbidity 1976. ANZ J Surg 72:689–698CrossRefPubMedGoogle Scholar
  24. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362: 1561–1571CrossRefPubMedGoogle Scholar
  25. Kolonel LN, Altshuler D, Henderson BE (2004) The multiethnic cohort study: exploring genes, lifestyle and cancer risk. Nat Rev Cancer 4:519–27CrossRefPubMedGoogle Scholar
  26. Kronborg O, Fenger C, Olsen J et al. (1996) Randomized study of screening for colorectal cancer with fecal occult blood test. Lancet 348: 1467–1471CrossRefPubMedGoogle Scholar
  27. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Longterm results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev CD003432Google Scholar
  28. Leung KL, Kwok SPY, Lam SCW et al. (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363: 1187–1192CrossRefPubMedGoogle Scholar
  29. Liebermann D (2008) Screening, surveillance and prevention of colorectal cancer. Gastroint Endosc Clin N Am 18: 595–605CrossRefGoogle Scholar
  30. Lobo DN, Bostock KA, Neal KR et al. (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359: 1812–1816CrossRefPubMedGoogle Scholar
  31. Lynch HT, Chapelle A de la (2003) Hereditary colorectal cancer. N Engl J Med 348: 919–923CrossRefPubMedGoogle Scholar
  32. Mandel JS (2008) Screening for colorectal cancer. Gastroenterol Clin N Am 37: 97–115CrossRefGoogle Scholar
  33. Mandel JS, Bond JH, Church TR et al. (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. N Eng J Med 328: 1365–1371CrossRefGoogle Scholar
  34. Marra F, Steffen T, Kallak N, Lange J, Zünd M (2009) Anastomotic leakage as a risk factor for the long term outcome after curative resection of colon cancer. Eur J Surg Oncol 35: 1060–1064PubMedGoogle Scholar
  35. Mc Ardle CS, Hole D (1991) Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. Br Med J 302: 1501–1505CrossRefGoogle Scholar
  36. Merrie AE, Phillips LV, Yun K, McCall JL (2001) Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection. Surgery 129:684–691CrossRefPubMedGoogle Scholar
  37. Meyerhardt JA, Meyer RJ (2005) Systemic therapy for colorectal cancer. New Engl J Med 352: 476–487CrossRefPubMedGoogle Scholar
  38. Milbourn D, Israelsson LA (2004) Wound complications and stitch length. Hernia 8: 39–41CrossRefGoogle Scholar
  39. Moertel CG, Flemming TR, Macdonald JS et al. (1995) Fluouracil plus levamisol as effective adjuvant therapy after resection of stage III colon carcinoma. A final report. Ann Intern Med 122: 321–326Google Scholar
  40. Mostafa G, Matthews BD, Norton HJ, Kercher KW, Sing RF, Heniford BT (2004) Influence of demographics on colorectal cancer. Am Surg 70: 259–263PubMedGoogle Scholar
  41. Munkholm P (2003) Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther 18:1–5CrossRefPubMedGoogle Scholar
  42. Nasir A, Boulware D, Kaiser HE et al. (2004) Flat and polypoid adenocarcinomas of the colorectum: A comparative histomorphologic analysis of 47 cases. Hum Pathol 35:604–611CrossRefPubMedGoogle Scholar
  43. Nelson RL, Glenny Am, Song F (2009) Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev CD 00181Google Scholar
  44. Read TE, Mutch MG, Chang BW et al. (2002) Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 195: 33–40CrossRefPubMedGoogle Scholar
  45. Satia JA, Campbell MK, Galanko JA, James A, Carr C, Sandler RS (2004) Longitudinal changes in lifestyle behaviors and health status in colon cancer survivors. Cancer Epidemiol Biomarkers 13:1022–1031Google Scholar
  46. Schmiegel W et al. (2005) S3-Leitlinie Kolorektales Karzinom 2004. Dtsch Med Wochenschr 130: S5–S53CrossRefPubMedGoogle Scholar
  47. Schmiegel W et al. (2008) Update S3-Leitlinie Kolorektales Karzinom 2008. Z Gastroenterol 46: 799–840CrossRefPubMedGoogle Scholar
  48. Schwenk W (2009) Fast Track Rehabilitation in der Viszeralchirurgie. Chirurg 80: 690–701CrossRefPubMedGoogle Scholar
  49. Stumpf M, Junge K, Krones C, Ulmer F, Klinge U, Schumpelick V (2009) Risikofaktoren für Anastomoseninsuffizienzen nach kolorektalen Eingriffen. Zentralbl Chir 134: 242–248CrossRefPubMedGoogle Scholar
  50. Tentes AA et al. (2009) Results of surgery for colorectal carcinoma with obstruction. Langenbecks Arch Surg 394: 49–53CrossRefPubMedGoogle Scholar
  51. Terry P et al. (2001) Fruits, vegetables, dietary fibre and risk of colorectal cancer. Nat Cancer Inst 93: 525–533CrossRefGoogle Scholar
  52. Triantafillidis JK et al. (2009). Colorectal cancer and inflammatory bowel disease: epidemiology, risk factors, mechanisms of carcinogenesis and prevention strategies. Anticancer Res 29: 2727–2737PubMedGoogle Scholar
  53. Urbach DR, Kennedy ED, Cohen MM (1999) Colon and rectal anastomoses do not require routine drainage. A systematic review and meta-analysis. Ann Surg 222: 174–180CrossRefGoogle Scholar
  54. Weitz J, Koch M, Debus J, Höhler T, Galle PR, Büchler MW (2005) Colorectal cancer. Lancet 365: 153–165CrossRefPubMedGoogle Scholar
  55. Wexner SD, Sands DR (2003) What’s new in colon and rectal surgery. J Am Coll Surg 196: 95–103CrossRefPubMedGoogle Scholar
  56. Wille-Jorgensen P, Guenaga KF, Matos D, Castro AA (2005) Pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis 7: 304–310CrossRefPubMedGoogle Scholar
  57. Wittekind C (2006) Use and problems of the TNM classification. Verh Dtsch Ges Pathol 90: 142–150PubMedGoogle Scholar
  58. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC (2003) Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 5:262–269CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • J.-P. Ritz
  • H. J. Buhr
    • 1
  1. 1.Chirurgische Klinik und PoliklinikCharité Universitätsmedizin Berlin, Campus Benjamin FranklinBerlin

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