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
Literatur
-
1
Allardyce R A, Morreau P, Bagshaw P F.
Operative factors affecting tumor cell distribution following laparoscopic colectomy in a porcine model.
Dis Colon Rectum.
1997;
4
939-945
-
2
Allardyce R A, Morreau P N, Frizelle F A, Bagshaw P F.
Tumour cell wound distribution after colectomy in a porcine model.
Aust N Z J Surg.
1998;
68
363-366
-
3
Bährlehner E, Heukrodt B, Anders S.
Laparoskopische Rektosigmoidresektion wegen Karzinom.
Minimal invasive Chirurgie.
1996 ;
5
97-103
-
4 Bennett C L, Stryker S J, Ferreira M R, Adams J, Beart R W, Jr. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. [published erratum appears in Arch Surg 1997 Jul;132 (7): 781] [see comments]. Arch Surg 132: 41-45
-
5
Berends F J, Kazemier G, Bonjer H J, Lange J F.
Subcutaneous metastases after laparoscopic colectomy [letter].
Lancet.
1994;
344
58
-
6
Bessler M, Whelan R L, Halverson A, Treat M R, Nowygrod R.
Is immune function better preserved after laparoscopic versus open colon resection?.
Surg.Endosc..
1994;
8
881-883
-
7
Boulez J.
[Surgery of colorectal cancer by laparoscopic approach].
Ann Chir.
1996;
50
219-230
-
8
Bouvet M, Mansfield P F, Skibber J M, Curley S A, Ellis L M, Giacco G G, Madary A R, Ota D M, Feig B W.
Clinical, pathologic, and economic parameters of laparoscopic colon resection for cancer.
Am J Surg.
1998;
176
554-558
-
9 Bouvy N D, Marquet R L, Jeekel H, Bonjer H J. Impact of gas (less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases [see comments]. Ann Surg 1996 224: 694-701
-
10
Bruch H, Schiedeck T, Schwandner O.
Laparoscopic Colorectal Surgery: A Five-Year Experience.
Dig Surg.
1999;
16
45-54
-
11
Bruch H P, Herold A, Schiedeck T HK, Schwandner O.
Laparoskopische Chirurgie des Rektumkarzinoms.
Zentralbl Chir.
1997;
122
1134-1141
-
12
Bruch H P, Schwandner O, Schiedeck T H, Roblick U J.
Actual standards and controversies on operative technique and lymph- node dissection in colorectal cancer.
Langenbecks Arch Surg.
1999;
384
167-175
-
13
Champault G, Lauroy J, Rizk N, Boutelier P.
[Neoplastic colonization of trocart paths. Should laparoscopic surgery be stopped for digestive cancers? (letter)].
Presse Med.
1994;
23
1313
-
14
Cirocco W C, Schwartzman A, Golub R W.
Abdominal wall recurrence after laparoscopic colectomy for colon cancer.
Surgery.
1994;
116
842-846
-
15
Fielding G A, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R.
Laparoscopic colectomy.
Surg Endosc.
1997;
11
745-749
-
16
Fleshman J W, Nelson H, Peters W R, Kim H C, Larach S, Boorse R R, Ambroze W, Leggett P, Bleday R, Stryker S, Christenson B, Wexner S, Senagore A, Rattner D, Sutton J, Fine A P.
Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group.
Dis Colon Rectum.
1996;
39
S 53-S 58
-
17
Fleshman J W, Wexner S D, Anvari M, LaTulippe J F, Birnbaum E H, Kodner I J, Read T E, Nogueras J J, Weiss E G.
Laparoscopic vs. open abdominoperineal resection for cancer.
Dis Colon Rectum.
1999 ;
42
930-939
-
18
Franklin M E, Jr., Rosenthal D, Abrego-Medina D, Dorman J P, Glass J L, Norem R, Diaz A.
Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results.
Dis Colon Rectum.
1996;
39
S 35-S 46
-
19
Franklin M E, Rosenthal D, Norem R F.
Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma multicenter study.
Surg Endosc.
1995;
9
811-816
-
20
Fusco M A, Paluzzi M W.
Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colon. Report of a case.
Dis. Colon Rectum.
1993;
36
858-861
-
21
Harmon G D, Senagore A J, Kilbride M J, Warzynski M J.
Interleu- kin- 6 response to laparoscopic and open colectomy.
Dis. Colon Rectum.
1994;
37
754-759
-
22
Hewett P J, Thomas W M, King G, Eaton M.
Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy. An in vivo model.
Dis Colon Rectum.
1996;
39
S 62-S 66
-
23
Hughes E S, McDermott F T, Polglase A L, Johnson W R.
Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery.
Dis Colon Rectum.
1983;
26
571-572
-
24
Iwanaka T, Arya G, Ziegler M M.
Mechanism and prevention of port-site tumor recurrence after laparoscopy in a murine model.
J Pediatr Surg.
1998;
33
457-461
-
25
Jeekel J.
Developments in colorectal cancer surgery.
Eur J Cancer.
1995;
31 A
1379-1381
-
26
Johnstone P A, Rohde D C, Swartz S E, Fetter J E, Wexner S D.
Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy.
J Clin Oncol.
1996;
14
1950-1956
-
27
Jones D B, Guo L W, Reinhard M K, Soper N J, Philpott G W, Connett J, Fleshman J W.
Impact of pneumoperitoneum on trocar site implantation of colon cancer in hamster model.
Dis Colon Rectum.
1995;
38
1182-1188
-
28
Jorgensen J O, McCall J L, Morris D L.
Port site seeding after laparoscopic ultrasonographic staging of pancreatic carcinoma [letter].
Surgery.
1995;
117
118-119
-
29
Khalili T M, Fleshner P R, Hiatt J R, Sokol T P, Manookian C, Tsushima G, Phillips E H.
Colorectal cancer: comparison of laparoscopic with open approaches.
Dis Colon Rectum.
1998;
41
832-838
-
30
Kockerling F, Reymond M A, Schneider C, Hohenberger W.
[Errors and risks in oncologic laparoscopic surgery].
Chirurg.
1997;
68
215-224
-
31
Lacy A M, Delgado S, Garcia-Valdecasas J C, Castells A, Pique J M, Grande L, Fuster J, Targarona E M, Pera M, Visa J.
Port site metastases and recurrence after laparoscopic colectomy. A randomized trial.
Surg Endosc.
1998;
12
1039-1042
-
32
Lee S W, Southall J, Allendorf J, Bessler M, Whelan R L.
Traumatic handling of the tumor independent of pneumoperitoneum increases port site implantation rate of colon cancer in a murine model.
Surg Endosc.
1998;
12
828-834
-
33
Leung K L, Yiu R Y, Lai P B, Lee J F, Thung K H, Lau W Y.
Laparoscopic-assisted resection of colorectal carcinoma: five-year audit.
Dis Colon Rectum.
1999;
42
327-333
-
34
Melotti G, Tamborrino E, Lazzaretti M G, Bonilauri S, Mecheri F, Piccoli M.
Laparoscopic surgery for colorectal cancer.
Semin Surg Oncol.
1999;
16
332-336
-
35
Milsom J W, Bohm B, Hammerhofer K A, Fazio V, Steiger E, Elson P.
A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report [see comments].
J Am Coll Surg.
1998;
187
46-55
-
36
Milsom J W, Fazio V W.
Concerns about laparoscopic colon cancer surgery [letter; comment].
Dis.Colon Rectum.
1994;
37
625-626
-
37
Monson J R, Hill A D, Darzi A.
Laparoscopic colonic surgery.
Br. J.Surg..
1995;
82
150-157
-
38
Nduka C C, Monson J R, Menzies Gow N, Darzi A.
Abdominal wall metastases following laparoscopy.
Br. J.Surg..
1994;
81
648-652
-
39
Neuhaus S J, Ellis T, Rofe A M, Pike G K, Jamieson G G, Watson D I.
Tumor implantation following laparoscopy using different insufflation gases [see comments].
Surg Endosc.
1998;
12
1300-1302
-
40
Neuhaus S J, Texler M, Hewett P J, Watson D I.
Port-site metastases following laparoscopic surgery.
Br J Surg.
1998;
85
735-741
-
41
Ortega A E, Beart R W, Jr., Steele G D, Jr., Winchester D P, Greene F L.
Laparoscopic Bowel Surgery Registry. Preliminary results.
Dis. Colon Rectum.
1995;
38
681-685
-
42
Pearlstone D B, Feig B W, Mansfield P F.
Port site recurrences after laparoscopy for malignant disease.
Semin Surg Oncol.
1999;
16
307-312
-
43
Poulin E C, Mamazza J, Schlachta C M, Gregoire R, Roy N.
Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma.
Ann Surg.
1999;
229
487-492
-
44
Prasad A, Avery C, Foley R J.
Abdominal wall metastases following laparoscopy [letter].
Br. J.Surg..
1994;
81
1697
-
45
Psaila J, Bulley S H, Ewings P, Sheffield J P, Kennedy R H.
Outcome following laparoscopic resection for colorectal cancer [see comments].
Br J Surg.
1998;
85
662-664
-
46
Ramos J M, Gupta S, Anthone G J, Ortega A E, Simons A J, Beart R WJ.
Laparoscopy and colon cancer. Is the port site at risk. A preliminary report?.
Arch.Surg..
1994;
129
897-899
-
47
Reilly W T, Nelson H, Schroeder G, Wieand H S, Bolton J, O'Connell M J.
Wound recurrence following conventional treatment of colorectal cancer. A rare but perhaps underestimated problem.
Dis Colon Rectum.
1996;
39
200-207
-
48
Santoro E, Carlini M, Carboni F, Feroce A.
Colorectal carcinoma: laparoscopic versus traditional open surgery. A clinical trial.
Hepatogastroenterology.
1999;
46
900-904
-
49
Schiedeck T H, Schwandner O, Baca I, Baehrlehner E, Konradt J, Kockerling F, Kuthe A, Buerk C, Herold A, Bruch H P.
Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study.
Dis Colon Rectum.
2000;
43
1-8
-
50
Schwandner O, Schiedeck T H, Killaitis C, Bruch H P.
A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer.
Int J Colorectal Dis.
1999;
14
158-163
-
51
Schwenk W, Bohm B, Haase O, Junghans T, Muller J M.
Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding.
Langenbecks Arch Surg.
1998;
383
49-55
-
52
Schwenk W, Neudecker J, Mall J, Bohm B, Muller J M.
Prospective randomized blinded trial of pulmonary function, pain, and cosmetic results after laparoscopic vs. microlaparoscopic cholecystectomy.
Surg Endosc.
2000;
14
345-348
-
53
Seow-Choen F, Eu K W, Ho Y H, Leong A F.
A preliminary comparison of a consecutive series of open versus laparoscopic abdomino-perineal resection for rectal adenocarcinoma.
Int J Colorectal Dis.
1997;
12
88-90
-
54
Stage J G, Schulze S, Moller P, Overgaard H, Andersen M, Rebsdorf-Pedersen V B, Nielsen H J.
Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma [see comments].
Br J Surg.
1997;
84
391-396
-
55
Stocchi L, Nelson H, Young-Fadok T M, Larson D R, Ilstrup D M.
Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study.
Dis Colon Rectum.
2000;
43
326-332
-
56
Tate J J, Kwok S, Dawson J W, Lau W Y, Li A K.
Prospective comparison of laparoscopic and conventional anterior resection.
Br. J.Surg..
1993;
80
1396-1398
-
57
Thomas W M, Eaton M C, Hewett P J.
A proposed model for the movement of cells within the abdominal cavity during CO2 insufflation and laparoscopy.
Aust N Z J Surg.
1996;
66
105-106
-
58
Watson D I, Mathew G, Ellis T, Baigrie C F, Rofe A M, Jamieson G G.
Gasless laparoscopy may reduce the risk of port-site metastases following laparascopic tumor surgery.
Arch Surg.
1997;
132
166-169
-
59
Wexner S D, Cohen S M.
Port site metastases after laparoscopic colorectal surgery for cure of malignancy.
Br. J.Surg..
1995;
82
295-298
-
60
Whelan R L, Sellers G J, Allendorf J D, Laird D, Bessler M D, Nowygrod R, Treat M R.
Trocar site recurrence is unlikely to result from aerosolization of tumor cells.
Dis Colon Rectum.
1996;
39
S 7-S 13
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