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Lokale Therapieprinzipien beim Rektumkarzinom

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Zusammenfassung

Im therapeutischen Algorithmus der Behandlung des Rektumkarzinoms, vor allem der beiden unteren Rektumdrittel, spielt die lokale Exzision derzeit eine zwar limitierte, aber klaren diagnostischen, onkologischen und technischen Prinzipien folgende Rolle. Dies ist besonders vor dem Hintergrund zu sehen, dass Aspekte des Funktionserhaltes und damit verbundene positive Auswirkungen auf die Lebensqualität bei zunehmender Kenntnis der Komplikationen radikaler Eingriffe und deren Auswirkungen vermehrt an Bedeutung gewinnen.

Im Folgenden werden die onkologisch-histologischen, die klinisch-diagnostischen und die technischen Prinzipien der lokalen Exzision sowie die Ergebnisse der nach dem resultierenden diagnostisch-therapeutischen Algorithmus behandelten und im Erlanger Register kolorektaler Karzinome (ERCRC) prospektiv erfassten Patienten dargestellt.

Abstract

In the therapeutic algorithm for treatment of rectal cancer, primarily in the lower two-thirds of the rectum, local excision currently plays a limited role, but clearly adheres to diagnostic, oncologic, and technical principles. This should be considered particularly against the background that aspects of maintaining function and the associated positive effects on quality of life, based on expanding knowledge of the complications of radical interventions and their ramifications, have gained in importance.

The following addresses the oncologic-histologic, clinical-diagnostic, and technical principles of local excision as well as the results for patients treated according to the devised diagnostic/therapeutic algorithm and included in the Erlanger Register of Colorectal Cancer (ERCRC).

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Literatur

  1. Beyon J, Mortensen NJ, Foy DM et al. (1989) Preoperative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography or computed tomography? Br J Surg 76:276–279

  2. Brodsky JT, Richard GK, Cohen AM et al. (1992) Variables correlated with the risk of lymphnode metastasis in early rectal cancer. Cancer 69:322–326

  3. Brown G., Radcliffe AG, Newcombe RG et al. (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90:355–364

  4. Bruch HP, Kolbert G (1997) Results of low resection and intersphincteric extirpation of rectal cancer. Chirurg 68:689–692

  5. Buess G, Kipfmüller K, Hack D et al. (1988) Technique of transanal endoscopic microsurgery. Surg Endo 2:71–75

  6. Deddish MR (1974) Local excision of cancer. Surg Clin North Am 54:877–880

  7. Dixon CF (1939) Surgical removal of lesions occuring in the sigmoid and rectosigmoid. Am J Surg 46:12

  8. Durdley PMS (1992) Preoperative evaluation of patients with low rectal carcinoma World J Surg 112:832–841

  9. Garcia.Aguilar J, Finne CO (1999) Local treatment of rectal cancer. In: Baily R (ed) Ambulatory anorectal surgery. Springer, New York, pp 187–203

  10. Goligher JC (1980) Treatment of carcinoma of the rectum. In: "Surgery of the anus, rectum and colon", 4th edn. Balliere Tindall, London, pp 502–666

  11. Gualdi GF, Casciani F, Guadalaxara A et al. (2000) Local staging of rectal cancer with transrecta ultrasound and endorectal magnetic resonance imaging: comparison with histopathologic findings. Dis Colon Rectum 43:338–345

  12. Hager TH, Gall FP, Hermanek P (1983) Local excision of cancer of the rectum. Dis Colon Rectum 26:149–151

  13. Haggit RC, Glotzbach RE, Sofler EE et al. (1985) Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 89:328–336

  14. Hermanek P (1994) Onkologische und histopathologische Grundlagen einer lokalen Therapie in kurativer Intention. In: Hermanek P, Marzoli GP (Hrsg) Lokale Therapie des Rektumkarzinoms. Spinger, Berlin Heidelberg New York, p 8

  15. Hermanek P, Marzoli GP (1994) Präselektion und definitive Selektion. In: Hermanek P, Marzoli GP (Hrsg) Lokale Therapie des Rektumkarzinoms. Spinger, Berlin Heidelberg New York, p 82

  16. Hohenberger W, Merkel S, Matzel KE et al. (eingereicht) The influence of abdominnoperanal (intersphincteric) resection of lower third rectal carcinoma on the rate of sphincter preservation and local recurrence rates. Colorect Dis

  17. Hohenberger W, Hermanek P Jr, Hermanek P et al. (1992) Decisionmaking in curative rectum carcinoma surgery. Onkologie 15:209–220

  18. Hohenberger W, Nömayr, A, Merkel S (2003) Chirurgische Therapie kolorektaler Karzinome. Internist 44:311–321

  19. Kessler H, Hermanek P. Wiebelt H (1993) Operative mortality in carcinoma of the rectum. Int J Colorect Dis 8: 158–166

  20. Kikuchi R, Takano M, Takagi K et al. (1995) Management of early invasive colorectal cancer. Risk of recurrence and clinical guideline. Dis Colon Rectum 38:1286–1295

  21. Killingback M (1992) Local excision of carcinoma of the rectum: Indications. World J Surg :437–463

  22. Köckerling F, Hermanek P, Gall FP (1994) Ergebnisse der Lokalen Therapie in Erlangen. In: Hermanek P, Marzoli GP (Hrsg) Lokale Therapie des Rektumkarzinoms. Springer, Berlin Heidelberg New York, S 121

  23. Lockhardt- Mummery JP (1920) Resection of the rectum for cancer. Lancet 1:20

  24. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460

  25. Matzel KE, Bittorf B, Günther K et al. (2003) Rectal resection with low anastomosis: functional outcome. Colorect Dis 5:458–464

  26. Miles WE (1908) A method of performing abdominoperineal excision for carcinoma of the rectum and the terminal portion of the pelvic colon. Lancet 2: 1812–1813

  27. Morson BC, Bussey HJ, Samoorian S (1977) Policy of local excision of early cancer of the colorectum. Gut 18:1045–1074

  28. Morson BC. (1966) Factors influencing the prognosis of early cancer of the rectum. Proc R Soc Med 59: 607–608

  29. Nicholls RJ. Mason AY, Morson BC et al. (1982) The clinical staging of rectal cancer. Br J Surg 69:404–409

  30. Rothenberger DA, Garcia-Aguilar J (2000) Role of local excision in the treatment of rectal cancer. Semin Surg Oncol 19:367–375

  31. Russell Ah, Harris J, Rosenberg PJ et al. (2000) Anal sphincter conservation for patients with adnocarcinoma of distal rectum: long-term results of radiation therapy oncology-group protocol 89–02. Int J Radiat Oncol Biol Phys 46:313–322

  32. Sengupta S, Tjandra JJ (2001) Local excision of rectal cancer. Dis Colon Rectum 44:1345–1361

  33. Sharma A, Hartley J, Monson JRT (2003) Local excision of rectal tumors. Surg Oncol 12:51–61

  34. Steele GD jr, Herndon JE, Bleday R et al. (1999) Sphinctersparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 6:433–441

  35. Vernerva AM, Moran M, Rothenberger DA et al. (1992) A prospective evalaution of distal margins in carcinoma of the rectum. Surg Gynecol Obstet 175:233–236

  36. Wagenstein OH (1945) Primary resection (closed anastomosis) of rcetal ampulla for malignancy with preservation of sphincter function. Surg Gynecol Obstet 81.1

  37. Willett CG, Compton CC, Shellito PC et al. (1994) Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer 73; 2716–2720

  38. Whiteway J, Nicholls RJ, Morson BC (1985) The role of surgical local excision in the treatment of rectal cancer. Br J Surg 72:694–697

  39. Zeni GC, Abraham K, Harford FJ et al. (1998) Characteristics of rectal carcinomas that predict the presence of lymph node metastases: implications for patient selection for local therapy. J Surg Oncol 67:99–103

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Authors and Affiliations

  1. Chirurgische Klinik, Universität Erlangen

    K. E. Matzel, S. Merkel & W. Hohenberger

  2. Chirurgische Klinik, Universität Erlangen, Krankenhausstraße 12, 91054 , Erlangen

    K. E. Matzel

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  1. K. E. Matzel
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  2. S. Merkel
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  3. W. Hohenberger
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Correspondence to K. E. Matzel.

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Matzel, K.E., Merkel, S. & Hohenberger, W. Lokale Therapieprinzipien beim Rektumkarzinom. Chirurg 74, 897–904 (2003). https://doi.org/10.1007/s00104-003-0745-0

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