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Chirurgie des Rektumkarzinoms

Surgery for rectal cancer

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Zusammenfassung

Die Chirurgie des Rektumkarzinoms hat im letzten Jahrzehnt weitere Fortschritte gemacht. Die partielle oder totale mesorektale Exzision (TME) ist Standardverfahren. Die chirurgische Qualität der TME hat prognostisch erheblich an Bedeutung gewonnen. Der zirkumferenzielle Resektionsrand (CRM) des Präparats stellt neben der Metastasierung den entscheidenden Prognosefaktor. Aktuelle Studien konnten einen distalen Resektionrand von 1 cm etablieren, was die Rate an kontinzenzerhaltenden Eingriffen gesteigert hat. Dies trifft insbesondere nach neoadjuvanter RCT zu. Die laparoskopische Rektumresektion ist in der Hand des erfahrenen Operateurs technisch sicher möglich, die onkologische Wirksamkeit kann noch nicht abschließend beurteilt werden. Die Therapie des Rektumkarzinoms besitzt multilaterale Ansätze und bleibt damit multimodal.

Abstract

During the last decade surgical treatment of rectal cancer has seen various improvements. Partial or total mesorectal excision (TME) became standard procedure. The surgical quality of the TME has a high effect on prognosis. Besides metastases, the circumferential resection margin receives the most attention. As recent studies established a distal resection margin of 1 cm, the rate of continence-preserving resections has grown, especially after neoadjuvant radiochemotherapy. In the hands of an expert, laparoscopic rectal resection is a technically safe procedure. Its oncological efficacy cannot yet be decided. Modern therapy for rectal cancer comprises multilateral considerations and therefore needs a multimodal orientation.

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Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Chirurgische Universitäts- und Poliklinik der RWTH Aachen, Pauwelsstraße 30, 52057, Aachen, Deutschland

    C. J. Krones, M. Stumpf & V. Schumpelick

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  1. C. J. Krones
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  2. M. Stumpf
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  3. V. Schumpelick
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Correspondence to C. J. Krones.

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Krones, C., Stumpf, M. & Schumpelick, V. Chirurgie des Rektumkarzinoms. Chirurg 80, 303–310 (2009). https://doi.org/10.1007/s00104-008-1621-8

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