Endoskopische Operationstechniken - Stellenwert beim kolorektalen Karzinom

Zusammenfassung.

Die laparoskopische Kolonchirurgie ist zur Zeit nur bei benignen Indikationen akzeptiert. Zur kurativen Therapie kolorektaler Karzinome wurde sie bislang nach anfänglich schlechten Ergebnissen abgelehnt. Inzwischen können mehrere Studien zeigen, dass die prinzipiellen Forderungen onkologischer Chirurgie auch laparoskopisch eingehalten werden können und dass im mittelfristigen Verlauf kein Unterschied zu konventionellen Ergebnissen besteht. Hinsichtlich Liegezeit, Blutverlust und Schmerzempfinden sind Vorteile für die laparoskopische Technik zu erkennen. Ungeklärte Fragen bleiben weiterhin Trokarkanalmetastasen und das Problem intraoperativ verschleppter Tumorzellen. Vieles deutet darauf hin, dass neben dem direkten Kontakt des Tumors mit Wundinzisionen kontaminierte Instrumente eine wichtige Rolle spielen. Die Bedeutung des Pneumoperitoneums wird kontrovers diskutiert. Solange diese Fragen unbeantwortet bleiben, kann die laparoskopische Karzinomchirurgie des Kolorektums nur im Rahmen von Studien empfohlen werden.

Endoscopic Surgery - it's role in colorectal Cancer.

At present laparoscopic colorectal Surgery is accepted in benign diseases only. According to bad results in the beginning up to now it was refused for curative treatment of colorectal cancer patients. Recent studies demonstrate that principles of oncologic surgery are not compromised by the laparoscopic approach and that there is no difference in the short and intermediate follow up compared to open surgery. Laparoscopic colorectal procedures offer several benefits postoperatively including hospitalisation time, bloodloss and reduction of pain. Unsolved issues are port-site recurrence and potential spread of tumor cells. Data are suggesting that beside of direct tumor-tissue contact contaminated instruments play a major role. The influence of pneumoperitoneum is discussed controversely. Therefore, in the interim, laparoscopic curative resections in colorectal cancer are only to be offered within controlled trials.

Schlüsselwörter:

Laparoskopie - Kolorektale Chirurgie - Kolorektales Karzinom - Minimalinvasive Chirurgie - Onkologie

Key words:

Laparoscopy - Colorectal Surgery - Colorectal Cancer - Minimalinvasive Surgery - Oncology

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