Zusammenfasung
Seit Einführung und Etablierung der totalen mesorektalen Exzision (TME) als chirurgisches Standard-Verfahren, hat sich die Prognose der Patienten mit einem Rektumkarzinom deutlich gebessert. So konnte allein durch die TME, unabhängig von multimodalen Therapiekonzepten, die Lokalrezidivrate auf unter 10 % gesenkt werden. Im Gegensatz dazu betrug sie vor der TME-Ära laut einer Deutschen Multizenterstudie noch im Jahre 1995 zwischen 4 und 55 % (Median 20 %). Ziel dieser Arbeit ist die Gegenüberstellung der multimodalen Therapiekonzepte mit ihren Ansprüchen sowie Vor- und Nachteilen anhand der in der aktuellen Literatur verfügbaren Daten. Neben der Lokalrezidivrate und der Überlebenszeit sollen auch die Toxizität, Kosten und Akzeptanz durch den Patienten betrachtet werden. Weiterhin soll aufgezeigt werden, wohin die Entwicklung der multimodalen Therapie derzeit tendiert, welche Konzepte bereits „Fakt” sind und welche wahrscheinlich „Fiktion” bleiben werden.
Abstract
The prognosis of patients with rectal cancer has been improved significantly after introduction of the total mesorectal excision (TME). Just by performing TME, the local recurrence rates could be decreased to less than 10 %, independent of multi-modal therapeutic concepts. In contrast, the local recurrence rate reached 4 to 55 % (median 20 %) in a German multicenter study in 1995 prior to the nationwide introduction of TME. The goal of this overview is to compare the different concepts in the multi-modal therapy of rectal cancer with their advantages and disadvantages based on the current literature. Mentioned will be local recurrence rates and survival, but also toxicity, costs and acceptance of patients. Furthermore, a preview is given about future developments.
Schlüsselwörter
Rektumkarzinom - TME - Strahlentherapie - multimodale Therapie - Kurzzeitstrahlentherapie
Key words
rectal carcinoma - total mesorectal excision - radiotherapy - multimodal treatment - short-term radiotherapy
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Prof. Dr. med. Dr. h. c. M. W. Büchler
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie · Ruprecht-Karls-Universität Heidelberg
Im Neuenheimer Feld 110
69120 Heidelberg
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eMail: markus_buechler@med.uni-heidelberg.de
