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Evidenzlage der laparoskopischen Chirurgie beim Kolonkarzinom

Current evidence for laparoscopic surgery of colonic cancer

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Zusammenfassung

Hintergrund

Die Entwicklung videoendoskopischer Techniken erlaubt die minimal-invasive Resektion von Kolonkarzinomen.

Fragestellung

Dieses Manuskript untersucht die Frage, ob Unterschiede im intraoperativen sowie kurz-, mittel- und langfristigen Verlauf bei laparoskopischen oder konventionellen Resektionen von Kolonkarzinomen bestehen.

Material und Methode

Es wurden randomisierte, kontrollierte Studien oder Metaanalysen aus diesen Studien ausgewertet.

Ergebnisse

Laparoskopische Resektionen von Kolonkarzinomen gehen mit etwas häufigeren intraoperativen Komplikationen und einer längeren Operationszeit bei geringerem Blutverlust einher. Die Gesamtkomplikationsquote und die Quote lokal-chirurgischer Komplikationen sind nach laparoskopischer Resektion eines Kolonkarzinoms weniger häufig. Die Inzidenz allgemeiner postoperativer Komplikationen und die Sterblichkeit sind bei beiden Operationstechniken nicht wesentlich verschieden. Der Krankenhausaufenthalt ist nach laparoskopischer Resektion kürzer, aber auch wesentlich von der perioperativen Behandlung abhängig. Die onkologischen Ergebnisse beider Operationstechniken (Tumorrückfall, Überleben) sind nicht verschieden. Wundimplantationen sind nach beiden Operationstechniken sehr selten, treten nach laparoskopischen Resektionen aber tendenziell etwas häufiger auf.

Schlussfolgerungen

Laparoskopische Resektionen von Kolonkarzinomen haben klinisch relevante Vorteile für den Patienten im kurz- bis mittelfristigen postoperativen Verlauf. Die onkologischen Ergebnisse beider Operationstechniken sind vergleichbar. Die vorliegenden Daten gelten bei Sigmaresektionen und links- oder rechtsseitigen Hemikolektomien. Zu laparoskopischen oder konventionellen erweiterten Resektionen bei Flexuren- oder Transversumkarzinomen gibt es keine hochwertige Evidenz. Geeignete Patienten mit Kolonkarzinomen sollten von laparoskopisch versierten Chirurgen laparoskopisch reseziert werden.

Abstract

Background

The development of modern videoendoscopy enables surgeons to perform laparoscopic resection of colonic cancer.

Aim

This manuscript evaluated the literature concerning clinically relevant differences in the short and long-term course after laparoscopic or conventional resection of colonic cancer.

Methods

An investigation of meta-analyses from randomized controlled clinical trials comparing laparoscopic and conventional surgery for colonic cancer was carried out.

Results

The incidence of intraoperative complications was higher during laparoscopic surgery, the duration of surgery was increased and blood loss was less when compared to open surgery. Overall morbidity and the incidence of surgical complications were decreased after laparoscopic surgery. General morbidity and mortality were not different after laparoscopic or open resection of colonic cancer. Duration of hospital stay was shorter but was also associated with the type of perioperative care (i.e. traditional or enhanced recovery). Following minimally invasive or conventional resection, the incidence of tumor recurrence (local and distant) and the duration of survival (overall and disease-free) showed no differences. Wound implantations were rare after both operative techniques but with a tendency to occur more often after laparoscopic than open resection.

Conclusion

Laparoscopic resection of colonic cancer has clinically relevant short-term benefits for the patients and long-term results are not different from open colectomy. However, most of the patients included in randomized controlled trials underwent right or left colectomy and sigmoid or rectosigmoid resections. Data with a high level of evidence concerning carcinomas of the flexures or the transverse colon do not exist. Suitable patients with colonic cancer should undergo laparoscopic resection by experienced surgeons.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Schwenk, J. Neudecker und O. Haase geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Allgemein- und Viszeralchirurgie – Zentrum für minimalinvasive und onkologische Chirurgie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland

    W. Schwenk FACS

  2. Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    J. Neudecker & O. Haase

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  1. W. Schwenk FACS
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  2. J. Neudecker
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  3. O. Haase
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Correspondence to W. Schwenk FACS.

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Schwenk, W., Neudecker, J. & Haase, O. Evidenzlage der laparoskopischen Chirurgie beim Kolonkarzinom. Chirurg 85, 570–577 (2014). https://doi.org/10.1007/s00104-014-2742-x

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  • DOI: https://doi.org/10.1007/s00104-014-2742-x

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