S3-Leitlinie Kolorektales Karzinom Version 1.0 – Juni 2013 AWMF-Registernummer: 021/007OL

1. Informationen zu dieser Leitlinie

1.1. Herausgeber

Leitlinienprogramm Onkologie der AWMF, Deutschen Krebsgesellschaft e. V. und Deutschen Krebshilfe e. V.

1.2. Federführende Fachgesellschaft

Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

Steuerungsgruppe für Planung und Durchführung über DGVS:
Univ.-Prof. Dr. Wolff Schmiegel
Dr. Christian P. Pox

1.3. Finanzierung der Leitlinie

Diese Leitlinie wurde von der Deutschen Krebshilfe im Rahmen des Onkologischen Leitlinienprogramms gefördert.

1.4. Kontakt

Leitlinienprogramm Onkologie Office
c/o Deutsche Krebsgesellschaft e. V.
Kuno-Fischer-Str. 8
14 057 Berlin

[e-mail]
www.leitlinienprogramm-onkologie.de

1.5. Zitierweise

Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 1.0, AWMF Registernummer: 021 – 007OL, http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html

1.6. Besonderer Hinweis

Die Medizin unterliegt einem fortwährenden Entwicklungsprozess, sodass alle Angaben, insbesondere zu diagnostischen und therapeutischen Verfahren, immer nur dem Wissensstand zurzeit der Drucklegung der Leitlinie entsprechen können. Hinsichtlich der angegebenen Empfehlungen zur Therapie und der Auswahl sowie Dosierung von Medikamenten wurde die größtmögliche Sorgfalt beachtet. Gleichwohl werden die Benutzer aufgefordert, die Beipackzettel und Fachinformationen der Hersteller zur Kontrolle heranzuziehen und im Zweifelsfall einen Spezialisten zu konsultieren. Fragliche Unstimmigkeiten sollen bitte im allgemeinen Interesse der OL-Redaktion mitgeteilt werden.

Der Benutzer selbst bleibt verantwortlich für jede diagnostische und therapeutische Applikation, Medikation und Dosierung.

In dieser Leitlinie sind eingetragene Warenzeichen (geschützte Warennamen) nicht besonders kenntlich gemacht. Es kann also aus dem Fehlen eines entsprechenden Hinweises nicht geschlossen werden, dass es sich um einen freien Warennamen handelt.

Das Werk ist in allen seinen Teilen urheberrechtlich geschützt. Jede Verwertung außerhalb der Bestimmung des Urhebergesetzes ist ohne schriftliche Zustimmung des Leitlinienprogramms Onkologie (OL) unzulässig und strafbar. Kein Teil des Werkes darf in irgendeiner Form ohne schriftliche Genehmigung des OL reproduziert werden. Dies gilt insbesondere für Vervielfältigungen, Übersetzungen, Mikroverfilmungen und die Einspeicherung, Nutzung und Verwertung in elektronischen Systemen, Intranets und dem Internet.

1.7. Ziele des Leitlinienprogramms Onkologie

Die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., die Deutsche Krebsgesellschaft e. V. und die Deutsche Krebshilfe e. V. haben sich mit dem Leitlinienprogramm Onkologie (OL) das Ziel gesetzt, gemeinsam die Entwicklung und Fortschreibung und den Einsatz wissenschaftlich begründeter und praktikabler Leitlinien in der Onkologie zu fördern und zu unterstützen. Die Basis dieses Programms beruht auf den medizinisch-wissenschaftlichen Erkenntnissen der Fachgesellschaften und der DKG, dem Konsens der medizinischen Fachexperten, Anwender und Patienten sowie auf dem Regelwerk für die Leitlinienerstellung der AWMF und der fachlichen Unterstützung und Finanzierung durch die Deutsche Krebshilfe. Um den aktuellen Stand des medizinischen Wissens abzubilden und den medizinischen Fortschritt zu berücksichtigen, müssen Leitlinien regelmäßig überprüft und fortgeschrieben werden. Die Anwendung des AWMF-Regelwerks soll hierbei Grundlage zur Entwicklung qualitativ hochwertiger onkologischer Leitlinien sein. Da Leitlinien ein wichtiges Instrument der Qualitätssicherung und des Qualitätsmanagements in der Onkologie darstellen, sollten sie gezielt und nachhaltig in den Versorgungsalltag eingebracht werden. So sind aktive Implementierungsmaßnahmen und auch Evaluationsprogramme ein wichtiger Bestandteil der Förderung des Leitlinienprogramms Onkologie. Ziel des Programms ist es, in Deutschland professionelle und mittelfristig finanziell gesicherte Voraussetzungen für die Entwicklung und Bereitstellung hochwertiger Leitlinien zu schaffen. Denn diese hochwertigen Leitlinien dienen nicht nur dem strukturierten Wissenstransfer, sondern können auch in der Gestaltung der Strukturen des Gesundheitssystems ihren Platz finden. Zu erwähnen sind hier evidenzbasierte Leitlinien als Grundlage zum Erstellen und Aktualisieren von Disease Management Programmen oder die Verwendung von aus Leitlinien extrahierten Qualitätsindikatoren im Rahmen der Zertifizierung von Organtumorzentren.

1.8. Autoren dieser Leitlinie

C. Pox, S. Aretz, S. C. Bischoff, U. Graeven, M. Hass, P. Heußner, W. Hohenberger, A. Holstege, J. Hübner, F. Kolligs, M. Kreis, P. Lux, J. Ockenga, R. Porschen, S. Post, N. Rahner, A. Reinacher-Schick, J. F. Riemann, R. Sauer, A. Sieg, W. Scheppach, W. Schmitt, H.-J. Schmoll, K. Schulmann, A. Tannapfel, W. Schmiegel

1.8.1. Zusammensetzung der Leitliniengruppe 2011/2012

Die Fachexpertengruppe für die Aktualisierung der Kapitel 3, 4, 5, 7, 10 (s. Abschnitt 2.2.1) setzte sich aus insgesamt 53 Mandatsträgern und Plenumsmitgliedern folgender Fachgesellschaften, Berufsverbände und Patientenvereinigungen zusammen:

• Fachgesellschaften

  • DKG (Deutsche Krebsgesellschaft)

    • ASORS (AG der DKG „Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin“)

    • PRIO (AG der DKG Prävention und integrative Medizin in der Onkologie)

    • PSO (AG der DKG: Dt. Arbeitsgemeinschaft für Psychoonkologie)

  • KOK (AG der DKG: Konferenz Onkologische Kranken- und Kinderkrankenpflege)

  • DGVS (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten)

  • DEGAM (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin)

  • DEGRO (Deutsche Gesellschaft für Radioonkologie)

  • DGAV (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie)

    • CACP (Chirurgische Arbeitsgemeinschaft für Colo-Proktologie)

    • CAMIC (Chirurgische Arbeitsgemeinschaft für Minimal-invasive Chirurgie)

    • CAO-V (Chirurgische Arbeitsgemeinschaft für Onkologie)

  • DGCH (Deutsche Gesellschaft für Chirurgie)

  • DGEM (Deutsche Gesellschaft für Ernährungsmedizin)

  • DGHO (Deutsche Gesellschaft für Hämatologie und Onkologie)

  • DGIM (Deutsche Gesellschaft für Innere Medizin)

  • DGKL (Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin)

  • DGN (Deutsche Gesellschaft für Nuklearmedizin)

  • DGP (Deutsche Gesellschaft für Pathologie)

  • DRG (Deutsche Röntgengesellschaft)

  • GfH (Deutsche Gesellschaft für Humangenetik)

• andere Institutionen

  • bng (Berufsverband Niedergelassener Gastroenterologen Deutschlands e. V.)

  • HÄV (Deutscher Hausärzteverband)

  • AQUA (Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen)

  • ZI (Zentralinstitut der Kassenärztlichen Versorgung in der BRD)

  • Felix-Burda-Stiftung

  • Stiftung Lebensblicke

• Patientenvereinigungen

  • DCCV (Deutsche Morbus Crohn/Colitis Ulcerosa Vereinigung)

  • Deutsche ILCO (Vereinigung für Stomaträger und für Menschen mit Darmkrebs)

[Tab. 1] zeigt die Zusammensetzung der Leitliniengruppe 2011/2012 unter der Leitung von Prof. Dr. W. Schmiegel (DKG, DGVS)

Tab. 1 Zusammensetzung der Arbeitsgruppen für die Aktualisierung der Kapitel 3, 4, 5, 7, 10.

Kapitel 3: Prävention asymptomatische Bevölkerung
Koordinator: J. F. Riemann	DGIM, DGVS, Stiftung Lebensblicke
Mitglieder: S. C. Bischoff	DGEM, DGVS
F. Kolligs	DGVS
J. Ockenga	DGEM, DGVS
W. Scheppach	DGEM, DGVS
Kapitel 4: Früherkennung/Vorsorge asymptomatische Bevölkerung
Koordinatoren: C. Pox, A. Sieg	beide DGVS
Mitglieder: L. Altenhofen	ZI
H-J. Brambs	DRG, DGAM
H. Brenner	Experte (nicht stimmberechtigt)
P. Engeser	HÄV
A. Theilmeier	bng, DGVS
Kapitel 5: Risikogruppen
Koordinatoren: N. Rahner K. Schulmann	GfH DGVS
G. Baretton	DGP
B. Bokemeyer	bng, DGVS
J. Epplen	DGHG
U. Melle	DGVS
R. Porschen	DGVS
J. Weitz	DGAV
C. Witte	DCCV
Kapitel 7: Präoperative Diagnostik und Chirurgie
Koordinatoren: W. Hohenberger S. Post	DKG, DGAV DKG, DGAV, CACP
M. Anthuber	DGAV
W. Bechstein	DGAV
U. Graeven	DGVS
M. Haß	Dt. ILCO
M. Heike	DGHO
K.-W. Jauch	DGAV
T. Kirchner	DGP
H. Lang	DKG, DGAV, CAO-V
K-H. Link	DKG, DGAV
P. Pereira	DRG
H-R. Raab	DGAV
A. Reinacher-Schick	DGVS
C. Rödel	DEGRO
M. Sailer	DGAV
R. Sauer	DEGRO
K. Scheidhauer	DGN
A. Tannapfel	DGP
T. Vogl	DRG
C. Wagener	DGKL
M. Walz	DGAV, CAMIC
C. Wittekind	DGP
Kapitel 10: Nachsorge
Koordinator: A. Holstege	DGVS
Mitglieder: P. Heußner	PSO
T. Höhler	DGHO
J. Hübner	DKG, PRIO
J. Körber	DKG, ASORS
M. Landenberger	DKG, KOK
H. Link	DKG, ASORS
Zusätzlich beim Plenum beteiligt
S. Ludt	AQUA
P. Lux	Mit-Autor (nicht stimmberechtigt)
C. Maar	Felix-Burda-Stiftung

1.8.2. Koordinatoren der Leitliniengruppe 2007/2008

Die Koordinatoren bei der Überarbeitung der Kapitel 6, 8 und 9 in 2007/2008 waren:

Kapitel 6 – Endoskopie: Durchführung und Polypenmanagement:
J. F. Riemann, W. Schmitt

Kapitel 8 – Adjuvante und neoadjuvante Therapie:
R. Porschen, R. Sauer

Kapitel 9 – Therapeutisches Vorgehen bei Metastasierung und in der palliativen Situation: U. Graeven, H-J. Schmoll

1.8.3. Zusammensetzung der AG Qualitätsindikatoren

Die Entwicklung der Vorschläge zu Qualitätsindikatoren erfolgte durch die in [Tab. 2] aufgeführte Arbeitsgruppe.

Tab. 2 Zusammensetzung der AG Qualitätsindikatoren.

Name	Institution
Koordinatoren: W. Schmiegel C. Pox	DKG, DGVS DGVS
Mitglieder: M. Haß	Dt. ILCO
W. Hohenberger	DKG, DGAV
A. Holstege	DGVS
F. Kolligs	DGVS
M. Klinkhammer-Schalke	Arbeitsgemeinschaft Deutscher Tumorzentren (ADT)
I. Kopp	AWMF, Leitlinienprogramm Onkologie
S. Ludt	AQUA
J. Ockenga	DGVS
S. Post	DKG, DGAV, CACP
A. Tannapfel	DGP
S. Wesselmann	Deutsche Krebsgesellschaft (DKG), Bereich Zertifizierung

1.8.4. Methodische Begleitung

Durch das Leitlinienprogramm Onkologie:

• Prof. Dr. Ina Kopp (AWMF), Marburg

• Dr. Markus Follmann, MPH MSc (DKG), Berlin

1.9. Verfügbare Dokumente zur Leitlinie und Implementierung

Bei diesem Dokument handelt es sich um die Langversion der S3-Leitlinie Kolorektales Karzinom, welche über die folgenden Seiten zugänglich ist:

• AWMF (www.leitlinien.net)

• Leitlinienprogramm Onkologie (http://www.leitlinienprogramm-onkologie.de/OL/leitlinien.html)

• Deutsche Krebsgesellschaft (http://www.krebsgesellschaft.de/wub_llevidenzbasiert,120 884.html)

• Deutsche Krebshilfe (http://www.krebshilfe.de/)

• Guidelines International Network (www.g-i-n.net)

• Beteiligte Fachgesellschaften (z. B. http://www.dgvs.de/508.php)

Darüber hinaus wird die Langversion dieser Leitlinie wird in der Zeitschrift für Gastroenterologie veröffentlicht werden.

Neben der Langfassung wird es die folgenden ergänzenden Dokumente zu dieser Leitlinie geben:

• Kurzversion

• Leitlinienreport

• Übersetzung (englisch)

• Patientenleitlinie

• Externer Evidenzbericht

Alle diese Dokumente werden ebenfalls auf den oben genannten Homepages abrufbar sein.

Der externe Evidenzbericht wurde zum Kapitel 4 (Vorsorge/Früherkennung) und Teilen des Kapitels 7 (präoperative Diagnostik und Chirurgie) von einer Kooperation der Universität Witten/Herdecke (Institut für Forschung in der Operativen Medizin) mit der Universität Duisburg/Essen (Alfried Krupp von Bohlen und Halbach Stiftungslehrstuhl für Medizinmanagement) erstellt.

Die Erstellung der Patientenleitlinie und die Übersetzung der Langversion ins Englische werden mit Fertigstellung der Leitlinie in Auftrag gegeben.

Eine flächendeckende Verbreitung dieser evidenzbasierten, aktuellen Verhaltensempfehlungen ist insbesondere für die Steigerung der Qualität bei Patienteninformation und -versorgung notwendig. Mithilfe standardisierter Methoden wurden von den Empfehlungen Qualitätsindikatoren abgeleitet. Diese dienen neben der Implementierung in erster Linie der Qualitätssicherung und -steigerung der patientenrelevanten Prozesse.

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