Download PDF
Zentralbl Chir 2007; 132(2): 85-94
DOI: 10.1055/s-2007-960623
Originalarbeiten und Übersichten

© Georg Thieme Verlag Stuttgart · New York

Qualitätsindikatoren bei Diagnostik und Therapie des Rektumkarzinoms

Quality Indicators for Diagnostic and Therapy of Rectal CarcinomaR. Bittner1 , J. Burghardt2 , E. Gross3 , R. T. Grundmann4 , P. Hermanek5 , C. Isbert6 , T. Junginger7 , F. Köckerling8 , S. Merkel9 , G. Möslein10 , H.-R. Raab11 , J. Roder12 , G. Ruf13 , W. Schwenk14 , J. Strassburg15 , A. Tannapfel16 , A. de Vries17 , H. Zühlke18
  • 1Arbeitsgruppe Workflow Rektumkarzinom II
    1 Klinik für Allgemein- und Viszeralchirurgie, Marienhospital, Stuttgart
  • 2Oskar-Ziethen-Krankenhaus, Berlin
  • 3I. Cirurgische Abteilung, AK Barmbeck, Hamburg
  • 4Kreiskliniken Altötting-Burghausen
  • 5Chirurgische Klinik und Poliklinik der Universität Erlangen-Nürnberg
  • 6Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Nürnberg
  • 7Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität, Mainz
  • 8Klinik für Chirurgie, Zentrum für Minimal-Invasive Chirurgie, Klinikum Hannover-Siloah
  • 9Klinisches Krebsregister, Chirurgische Universitätsklinik, Erlangen
  • 10Abtlg. für Chirurgie, St. Josef Hospital, Bochum-Linden
  • 11Klinik für Allgemein- und Viszeralchirurgie, Klinikum Oldenburg
  • 12Abt. für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Kreisklinik Altötting
  • 13Abtlg. für Allgemein- und Viszeralchirurgie, Chirurgische Universitätsklinik, Freiburg
  • 14Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité Campus Mitte, Berlin
  • 15Chirurgische Klinik, Vivantes Klinikum im Friedrichshain, Berlin
  • 16Institut für Pathologie, Ruhr-Universität Bochum
  • 17Abtlg. für Radio-Onkologie, Landeskrankenhaus Feldkirch, Austria
  • 18Klinik für Allgemein-, Viszeral- und Gefäßchirurgie / Phlebologie, Lutherstadt Wittenberg
Further Information

Publication History

Publication Date:
03 January 2008 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Diagnostik und Therapie des Rektumkarzinoms bedürfen einer laufenden Qualitätssicherung. Für eine zusammenfassende Beurteilung wurden Qualitätsindikatoren in Form eines sog. Indikatorprofils zusammengestellt. Dabei wurden solche Indikatoren ausgewählt, bei denen Abweichungen vom Qualitätsziel in einem nennenswerten Anteil zu erwarten und die vor allem für das Outcome maßgeblich sind. Für die Beurteilung der klinischen Diagnostik wurden die Häufigkeit der Festlegung der prätherapeutischen T-, N- und M-Kategorien und der Anteil von pT 1-Tumoren, für die pathologische Diagnostik die Zahl histologisch untersuchter Lymphknoten und der Anteil lymphknotenpositiver Patienten ausgewählt. Von Indikatoren der Prozessqualität der Therapie wurden aufgenommen: Anteile von Tumorentfernung, definitiver Therapie durch lokale Tumorentfernung, neoadjuvanter Langzeit-Radiochemotherapie, adjuvanter Therapie bei nicht neoadjuvant behandelten Patienten, totaler / partieller Mesorektumexzision, abdominoperinealer Rektumexstirpation, postoperativer Letalität, klinisch manifester Anastomoseninsuffizienz und neurogener Harnblasenentleerungsstörung bei Krankenhausentlassung. Bei den Indikatoren der Ergebnisqualität der Therapie wird zwischen sog. Surrogatindikatoren, die schon nach Durchführung der chirurgischen Ersttherapie bestimmt werden können und zu diesem frühen Zeitpunkt starke Hinweise auf den weiteren Krankheitsverlauf geben, und definitiven Indikatoren unterschieden. Als Surrogatindikatoren sind von Bedeutung die Häufigkeiten von intraoperativer örtlicher Tumorzelldissemination, R 1 / 2-Resektion und pathohistologisch CRM-positiver Tumorentfernung sowie die Qualität der Mesorektumexzision (Anteil inkompletter Mesorektumexzisionen). Als definitive Indikatoren werden die 5-Jahres-Lokalrezidivrate und die 5-Jahres-Gesamtüberlebensrate empfohlen. Die entsprechenden Zielparameter für die einzelnen Indikatoren werden in dieser Arbeit mit konkreten Zahlen hinterlegt.

Abstract

Diagnostic and treatment of rectal cancer need a continuous quality assessment. Indicators of quality were compiled as indicator profile for a summarizing evaluation. The indicators selected should potentially show an appreciable variation of the quality target and in addition should be decisive for the outcome. For the evaluation of the clinical diagnostic the frequency of the determination of the pretherapeutic T, N and M categories and the proportion of pT 1-tumors were chosen, for the pathological diagnostic the number of histologically examined lymph nodes and the proportion of lymphnode positive patients. Process quality of treatment was defined by the following indicators: proportion of tumor excision, of definite therapy by local tumor removal, of neo-adjuvant long-term radiochemotherapy, of adjuvant treatment in patients not selected for neoadjuvant therapy, of total / partial mesorectal excision, of abdomino-perineal resection, postoperative mortality, frequency of clinically apparent anastomotic leakage, and of neurogenic bladder dysfunction at hospital discharge. The indicators for the quality of the performance of treatment were differentiated between surrogate indicators that can be determined immediately after accomplishment of primary surgical therapy giving strong clues for the further course of disease at an early date, and definite indicators. Important surrogate indicators comprise the occurrence of intraoperative local tumor cell dissemination, R 1 / 2-resection, pathohistologically CRM-positive tumor resection, and the quality of mesorectal excision (proportion of incomplete mesorectal excision). The definite indicators include the 5-year local recurrence rate and the 5-year overall survival rate. The corresponding quantifying parameters for the individual indicators are specified in this paper with precise figures.

Schlüsselwörter

Rektumkarzinom - Qualität der Behandlung - Qualitätsindikatoren - Qualitätserfassung

Key words

rectal carcinoma - quality of treatment - quality indicators - quality assessment

Literatur

  • 1 Abrams J. Disease-free survival versus overall survival as a primary endpoint for adjuvant colon cancer studies: a commentary.  J Clin Oncol. 2005;  34 8564-8565
    PubMedGoogle Scholar
  • 2 Buhr H J, Dommisch K, Fleischer G-M. et al . Klinischer Ablaufpfad (Workflow) zu Diagnostik, Therapie und Nachsorge des Rektumkarzinoms.  Zbl Chir. 2006;  131 285-297
    PubMedGoogle Scholar
  • 3 Ärztliche Zentralstelle Qualitätssicherung (ÄZQ) .Beurteilung klinischer Messgrößen des Qualitätsmanagements - Qualitätskriterien und -indikatoren in der Gesundheitsversorgung - Konsenspapier der Bundesärztekammer, der Kassenärztlichen Bundesvereinigung und der AWMF.  www.azq.de 2001
    Google Scholar
  • 4 Alves A, Panis Y, Trancart D. et al . Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients.  World J Surg. 2002;  26 499-502
    CrossrefPubMedGoogle Scholar
  • 5 Arbman G, Nilsson E, Hallbrock O, Sjödahl R. Local recurrence following total mesorectal excision for rectal cancer.  Br J Surg. 1996;  83 375-379
    CrossrefPubMedGoogle Scholar
  • 6 Beets-Tan R GH. MRI in rectal cancer: the T stage and circumferential resection margin.  Colorectal Dis. 2003;  5 392-395
    CrossrefPubMedGoogle Scholar
  • 7 Beets-Tan R GH, Beets G L. Rectal cancer: Review with emphasis on MR imaging.  Radiol. 2004;  232 335-346
    PubMedGoogle Scholar
  • 8 Begg C B, Leung D HY. On the use of surrogate end points in randomized trials.  J E Stat Soc (Ser A). 2000;  163 15-24
    PubMedGoogle Scholar
  • 9 Berufsverband Deutscher Pathologen und Deutsche Gesellschaft für Pathologie .Empfehlungen zur pathologisch-anatomischen Diagnostik des kolorektalen Karzinoms. Berufsverband Deutscher Pathologen, Gelsenkirchen. www.bv-pathologie.de 2005
    Google Scholar
  • 10 Birbeck K F, Macklin C P, Tiffin N J. et al . Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery.  Ann Surg. 2002;  35 449-457
    PubMedGoogle Scholar
  • 11 Blomqvist L, Holm T, Nyren S. et al . MR imaging and computed tomography in patients with rectal tumors clinically judged as locally advanced.  Clin Radiol. 2002;  40 3-10
    PubMedGoogle Scholar
  • 12 Bokey E L, Chapuis P H, Dent O F. et al . Factors affecting survival after excision of the rectum for cancer: a multivariate analysis.  Dis Colon Rectum. 1997;  40 3-10
    PubMedGoogle Scholar
  • 13 Bokey E L, Öjerskog B, Chapuis P H. et al . Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection.  Brit J Surg. 1999;  86 1164-1170
    CrossrefPubMedGoogle Scholar
  • 14 Bollschweiler E, Ekkenkamp A, Hölscher A H, Bauer H. Wie werden wir Qualität in der Chirurgie darstellen? Pflicht zum Qualitätsbericht im Internet in 2005.  Mittlg Dtsch Ges Chir. 2003;  4/03 353-356
    PubMedGoogle Scholar
  • 15 Bonadeo F A, Vaccato C A, Benati M L. et al . Local recurrence after surgery without radiotherapy.  Dis Colon Rectum. 2001;  44 374-379
    CrossrefPubMedGoogle Scholar
  • 16 Brown G. Thin section MRI in multidisciplinary preoperative decision making for patients with rectal cancer.  Br J Radiol. 2005;  78 special issue S117-S127
    PubMedGoogle Scholar
  • 17 Brown G, Richards C J, Newcombe R G. et al . Rectal carcinoma: thin-section MR imaging for staging in 28 patients.  Radiol. 1999;  211 215-222
    PubMedGoogle Scholar
  • 18 Brown G, Radcliffe A G, Newcombe R G. et al . Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging.  Br J Surg. 2003;  90 355-364
    CrossrefPubMedGoogle Scholar
  • 19 Brown G, Daniels I R. Preoperative staging of rectal cancer: The MERCURY research project.  Recent Results Cancer Research. 2005;  105 58-74
    PubMedGoogle Scholar
  • 20 Büchler M W, Heald R J, Maurer C A, Ulrich B. (Hrsg) .Rektumkarzinom: Das Konzept der Totalen Mesorektalen Exzision. Karger, Basel 1998
    Google Scholar
  • 21 Bundesärztekammer (Hrsg) .Leitfaden: Qualitätsmanagement im deutschen Krankenhaus. W. Zuckschwerdt, München, Bern, Wien, New York 1997
    Google Scholar
  • 22 Burton S, Brown G, Daniels I R. et al. on behalf of the Royal Marsden Hospital, Colorectal Cancer Network . MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?.  Br J Cancer. 2006;  94 351-357
    CrossrefPubMedGoogle Scholar
  • 23 Buyse M, Molenberghs G. Criteria for the validation of surrogate endpoints in randomized experiments.  Biometrics. 1998;  54 1014-1929
    CrossrefPubMedGoogle Scholar
  • 24 Buyse M, Molenberghs G, Burzykowski T. et al . The validation of surrogate endpoints in meta-analyses of randomized experiments.  Biostatistics. 2000;  1 49-67
    CrossrefPubMedGoogle Scholar
  • 25 Carlsen E, Schlichting E, Gildvog I. et al . Effect of the introduction of total mesorectal excision for the treatment of rectal cancer.  Br J Surg. 1998;  85 526-529
    CrossrefPubMedGoogle Scholar
  • 26 Cecil T, Sexton R, Moran B J, Heald R J. Total mesorectal excision results in low local recurrence rates in node positive rectal cancer.  Dis Colon Rectum. 2004;  47 1145-1150
    PubMedGoogle Scholar
  • 27 Compton D D. Pathologic prognostic factors in the recurrence of rectal cancer.  Clin Colorect Cancer. 2002;  2 149-160
    PubMedGoogle Scholar
  • 28 Daniels I R, Moran B J, Heald R J. Surgery alone: Is total mesorectal excision sufficient for rectal cancer?. In: Wiegel T, Höcht S, Sternemann M, Buhr HJ, Hinkelbein W (eds). Controversies in gastrointestinal tumor therapy. Karger, Basel 2004; 28-36
    Google Scholar
  • 29 Daniels J R, Strassburg J, Moran B J. The need for future surgical low rectal cancer studies.  Colorect Diseases. 2006;  8 (Suppl 3) 25-29
    PubMedGoogle Scholar
  • 30 Dehni N, Schlegel R G, Cunningham C. et al . Influence of a defunctioning stoma in leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis.  Br J Surg. 1998;  85 1114-1117
    CrossrefPubMedGoogle Scholar
  • 31 Dehni N, McFadden N, McNamara D A. et al . Oncologic results following abdominoperineal resection for adenocarcinoma of the low rectum.  Dis Colon Rectum. 2003;  46 867-874
    PubMedGoogle Scholar
  • 32 Hermanek P. (Hrsg) .Diagnostische Standards. Lungen-, Magen-, Pankreas- und kolorektales Karzinom. Zuckschwerdt, München, Berlin, Wien, New York 1995; 95-121, 124 ff
    Google Scholar
  • 33 Dinter D, Willeke F, Strauss L. et al . Staging des Rektumkarzinoms mit CT, MRT und PET.  Chir Prax. 2006;  66 175-196
    PubMedGoogle Scholar
  • 34 Donabedian A. Evaluating the quality of medical care. Millbank Memorial Fund Quarterly 1966; 44: 166-206, zit. n. Cook A, Hyman N. Quality assessment and improvement in colon and rectal surgery.  Dis Colon Rectum. 2004;  47 2195-2201
    CrossrefPubMedGoogle Scholar
  • 35 Engel A F, Oomen J LT, Eijsbouts Q AJ. et al . Nationwide decline in annual numbers of abdomino-perineal resections: effect of a successful national trial?.  Colorect Disease. 2003;  5 180-184
    PubMedGoogle Scholar
  • 36 Engel J, Kerr J, Eckel R. et al . Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients.  Eur J Surg Oncol. 2005;  31 512-520
    CrossrefPubMedGoogle Scholar
  • 37 Enker W E, Thaler H T, Cranor M L. et al . Total mesorectal excision in the operative treatment of carcinoma of the rectum.  J Am Coll Surg. 1995;  181 335-346
    PubMedGoogle Scholar
  • 38 Enker W E, Merchant N, Cohen A M. et al . Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specially service.  Ann Surg. 1999;  230 544-552
    CrossrefPubMedGoogle Scholar
  • 39 Eriksen M T, Wibe A, Syse A. et al . Inadvertent perforation during rectal cancer resection in Norway.  Br J Surg. 2004;  91 210-216
    CrossrefPubMedGoogle Scholar
  • 40 Faivre J. Surveillance endoscopique apres exerese d'un cancer colorectal (endoscopic monitoring after excision of colorectal cancer).  Journal de Chirurgie. 1997;  134 283-285
    PubMedGoogle Scholar
  • 41 Fielding L P, Arsenault P A, Chapuis P H. et al . Clinicopathological staging for colorectal cancer: An International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT).  J Gastroenterol Hepatol. 1991;  6 325-344
    CrossrefPubMedGoogle Scholar
  • 42 Fietkau R, Rödel C, Hohenberger W. et al . Rectal Cancer: Delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: results of study CAO / ARO / AIO-94.  Int J Radiation Oncol Biol Phys. 2007;  67 1008-1019
    CrossrefPubMedGoogle Scholar
  • 43 Fink A S, Campbell D A, Mentzer R M. et al . The national surgical quality improvement program in Non-Veterans Administration hospitals: initial demonstration of feasibility.  Ann Surg. 2002;  236 344-354
    CrossrefPubMedGoogle Scholar
  • 44 Fisher S, Daniels I R. Quality of life and sexual function following surgery for rectal cancer.  Colorect Disease. 2006;  8 (Suppl 3) 40-42
    PubMedGoogle Scholar
  • 45 Fleming T R, DeMets D L. Surrogate end points in clinical trials: Are we being misled?.  Ann Intern Med. 1996;  126 605-613
    PubMedGoogle Scholar
  • 46 Freedman L S, Granbard B L, Schatzkin A. Statistical validation of intermediate endpoints for chronic disease.  Stat Med. 1992;  11 167-178
    CrossrefPubMedGoogle Scholar
  • 47 Glimelius B, Grönberg H, Järhult J. et al . A systematic overview of radiation therapy effects in rectal cancer.  Acta Oncol. 2003;  42 476-492
    PubMedGoogle Scholar
  • 48 Göhl J, Merkel S, Rödel C, Hohenberger W. Can neoadjuvant radiochemotherapy improve the results of multivisceral resections in advanced rectal carcinoma (cT 4 a)?.  Colorect Disease. 2003;  5 436-441
    CrossrefPubMedGoogle Scholar
  • 49 Göhl J, Merkel S, Hohenberger W. Laparoscopic TME - the surgeon's or the patient's preference.  Recent Results Cancer Research. 2005;  165 158-166
    PubMedGoogle Scholar
  • 50 Goldstein N S, Sanford W, Coffrey M, Layfield L J. Lymph node recovery from colorectal resection specimens removed for adenocarcinoma: trends over time and a recommendation for a minimum number of lymph nodes to be removed.  Am J Clin Pathol. 2000;  106 209-216
    PubMedGoogle Scholar
  • 51 Greene F L, Stewart A K, Norton H J. New tumor-node-metastasis staging strategy for node-positive (stage III) rectal cancer: an analysis.  J Clin Oncol. 2004;  22 1778-1784
    CrossrefPubMedGoogle Scholar
  • 52 Gunderson L L, Sargent D J, Tepper J E. et al . Impact of T and N substage on survival and disease relapse in adjuvant rectal cancer: A pooled analysis.  Int J Radiat Oncol Biol Phys. 2002;  54 386-396
    CrossrefPubMedGoogle Scholar
  • 53 Gunnarsson U, Seligsohn E, Jestin P, Pahlman L. Registration and validity of surgical complications in colorectal cancer surgery.  Br J Surg. 2003;  90 454-459
    CrossrefPubMedGoogle Scholar
  • 54 Hammermeister K E, Shroyer A L, Sethi G K, Grover F L. Why it is important to demonstrate linkages between outcome of care and processes and structures of care.  Med Care. 1995;  33 OS5-OS16
    PubMedGoogle Scholar
  • 55 Harmon J W, Tang D G, Gordon T A. et al . Hospital volume can serve a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection.  Ann Surg. 1999;  230 404-411
    CrossrefPubMedGoogle Scholar
  • 56 Havenga K, Enker W E, McDermott K. et al . Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum.  J Am Coll Surg. 1996;  182 495-502
    PubMedGoogle Scholar
  • 57 Havenga K, Enker W E, Norstein J. et al . Improved survival and local control after total mesorectal excision or D 3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients.  Eur J Surg Oncol. 1999;  25 368-374
    PubMedGoogle Scholar
  • 58 Havenga K, Maas C, de Ruiter M. et al . Avoiding long-term disturbance to bladder and sexual function in pelvis surgery, particularly with rectal cancer.  Semin Surg Oncol. 2000;  18 235-243
    CrossrefPubMedGoogle Scholar
  • 59 Heald R J. Anterior resection of the rectum. In: Fielding LP, Goldberg SM (eds). Surgery of the colon, rectum an anus. 5th ed. Chapman & Hall Medical, London, Glasgow, Weinheim, New York 1993; 456-471
    Google Scholar
  • 60 Heald R J, Husband E M, Ryall R D. The mesorectum in rectal cancer surgery - the clue of pelvic recurrence?.  Br J Surg. 1982;  69 613-616
    CrossrefPubMedGoogle Scholar
  • 61 Heald R J, Karanjia B D. Results of radical surgery for rectal cancer.  World J Surg. 1992;  16 848-857
    CrossrefPubMedGoogle Scholar
  • 62 Heald R J, Smedh R K, Kald A. et al . Abdominoperineal excision of the rectum. An endangered operation.  Dis Colon Rectum. 1997;  40 747-751
    CrossrefPubMedGoogle Scholar
  • 63 Heald R J, Daniels I R. Rectal cancer management: Europe is ahead.  Recent Results Cancer Research. 2005;  165 75-81
    PubMedGoogle Scholar
  • 64 Hermanek P. Onkologische und histopathologische Grundlagen einer lokalen Therapie in kurativer Intention. In: Hermanek P, Marzoli GP (Hrsg). Lokale Therapie des Rektumkarzinoms in kurativer Intention. Springer, Berlin, Heidelberg, New York 1994; 7-19
    Google Scholar
  • 65 Hermanek P. Qualitätsmanagement bei Diagnose und Therapie kolorektaler Karzinome.  Leber Magen Darm. 1996;  26 20-24
    PubMedGoogle Scholar
  • 66 Hermanek P. Qualität der Chirurgie aus der Sicht des Pathologen. In: Büchler MW, Heald RJ, Maurer CA, Ulrich B (Hrsg). Rektumkarzinom. Das Konzept der totalen mesorektalen Exzision. Karger, Basel 1998; 211-219
    Google Scholar
  • 67 Hermanek P, Wiebelt H, Staimmer D. et al . Prognostic factors of rectum carcinoma - experience of the German multicenter study SGCRC.  Tumori. 1995;  81 (Suppl) 60-64
    PubMedGoogle Scholar
  • 68 Hermanek P, Hohenberger W. The importance of volume in colorectal cancer surgery.  Eur J Surg Oncol. 1996;  22 213-215
    CrossrefPubMedGoogle Scholar
  • 69 Hermanek P, Mansmann U, Altendorf-Hofmann A. et al. für die Studiengruppe Kolorektales Karzinom (SGKRK) . Vergleichende Beurteilung der onkologischen Ergebnisqualität beim colorectalen Carcinom. Klinikvergleiche anhand von Surrogatendpunkten?.  Chirurg. 1999;  70 407-414
    CrossrefPubMedGoogle Scholar
  • 70 Hermanek P, Hermanek P jr, Hohenberger W. et al . The pathological assessment of mesorectal excision - implications for further treatment and quality assessment.  Int J Colorect Dis. 2003;  18 335-341
    PubMedGoogle Scholar
  • 71 Hermanek P, Junginger T. The circumferential resection margin in rectal carcinoma surgery.  Tech Coloproctol. 2005;  9 193-200
    CrossrefPubMedGoogle Scholar
  • 72 Hermanek P, Junginger T, Merkel S, Oberholzer K. High-resolution magnetic resonance imaging (MRI) in patients with rectal carcinoma: Effectiveness in selection for neoadjuvant treatment. In: Recent Research Developments in Cancer. Vol. 8 (Pandala SG, ed). Transworld Research Network, Trivandrum, Kerala, India 2006; 39-56
    Google Scholar
  • 73 Hermanek P jr, Mansmann U, Staimmer D. et al . The German experience: The surgeon as a prognostic factor in colon and rectal cancer surgery.  Surg Oncol Clin N Amer. 2000;  9 33-49
    PubMedGoogle Scholar
  • 74 Hill G L, Rafique M. Extrafascial excision of the rectum for rectal cancer.  Br J Surg. 1998;  85 809-812
    CrossrefPubMedGoogle Scholar
  • 75 Hodgson D C, Thang W, Zaslavsky A M. et al . Relation of hospital volume to colostomy rates and survival for patients with rectal cancer.  J Natl Cancer Inst. 2003;  95 708-716
    PubMedGoogle Scholar
  • 76 Hohenberger P. Colorectal cancer - what is standard surgery?.  Eur J Cancer. 2001;  37 Suppl 173-187
    PubMedGoogle Scholar
  • 77 Hohenberger W. The effect of specialization or organisation of rectal cancer surgery. In: Soreide O, Norstein J (eds). Rectal cancer surgery. Optimisation - standardisation - documentation. Springer, Berlin, Heidelberg, New York 1997; 353-363
    Google Scholar
  • 78 Holm T, Rutqvist L E, Johnston H, Cedermark B. Abdominoperineal resection and anterior resection in the treatment of rectal cancer: results in relation to adjuvant preoperative radiotherapy.  Br J Surg. 1995;  82 1213-1216
    PubMedGoogle Scholar
  • 79 Jessup J B, Stewart A K, Menck H R. The National Cancer Data Base report on patterns of care for adenocarcinoma of the rectum, 1985-1995.  Cancer. 1998;  83 2408-2418
    CrossrefPubMedGoogle Scholar
  • 80 Junginger T, Kneist W, Sultanov F, Heintz A. Qualitätsindikatoren der chirurgischen Therapie des Rektumkarzinoms.  Chirurg. 2003;  74 444-451
    CrossrefPubMedGoogle Scholar
  • 81 Junginger T, Lorenz W. (Hrsg) .Interdisziplinäre S 3-Leitlinie „Diagnostik, Therapie und Nachsorge des kolorektalen Karzinoms”.  www.klinik.uni-mainz.de/Allgemeinchir/Leitlinienmanuskript.pdf 2004
    Google Scholar
  • 82 Junginger T, Hermanek P, Oberholzer K, Schmidberger H. Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation.  Zbl Chir. 2006;  131 275-284
    Article in Thieme ConnectPubMedGoogle Scholar
  • 83 Karanjia N D, Corder A P, Bearn P, Heald R J. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum.  Br J Surg. 1994;  81 1224-1226
    CrossrefPubMedGoogle Scholar
  • 84 Kastl S, Merkel S, Hohenberger W. Prozessqualität bei der Therapie des colorectalen Karzinoms: Lokale iatrogene Tumorzelldissemination trotz standardisierten chirurgischen Vorgehens. Abstract 12. Informationstagung Tumordokumentation 1999
    Google Scholar
  • 85 Khuri S F, Saley J, Henderson W. et al . Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: Results of the National Veterans Affairs Surgical Risk Study.  J Am Coll Surg. 1997;  185 315-327
    CrossrefPubMedGoogle Scholar
  • 86 Khuri S, Daley J, Henderson W G. et al . The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care.  Ann Surg. 1998;  228 491-507
    CrossrefPubMedGoogle Scholar
  • 87 Kim D G, Madoff R D. Transanal treatment of rectal cancer: ablative methods and open resection.  Seminars Surg Oncol. 1998;  15 101-113
    CrossrefPubMedGoogle Scholar
  • 88 Köckerling F, Reymond M A, Altendorf-Hofmann A. et al . Influence of surgery on metachronous distant metastases and survival in rectal cancer.  J Clin Oncol. 1998;  16 324-329
    PubMedGoogle Scholar
  • 89 Köckerling F, Lippert H, Gastinger I. (Hrsg) .Fortschritte in der kolorektalen Chirurgie. Science Med, Hannover 2002
    Google Scholar
  • 90 Kopp I, Koller M, Stinner B. et al . Therapie des Rektumkarzinoms. Abbildung der realen Versorgungssituation im Rahmen einer krebsbezogenen Qualitätssicherungsstudie.  Chirurg. 2001;  72 1467-1477
    CrossrefPubMedGoogle Scholar
  • 91 Krook J E, Moertel G G, Gundersson L L. et al . Effective surgical adjuvant therapy for high risk rectal carcinoma.  N Engl J Med. 1991;  324 709-715
    CrossrefPubMedGoogle Scholar
  • 92 Kutz R, Wölfl G, Grünzinger E, Hofstädter F. Externe Qualitätssicherung (Qualitätsindikatoren) kolorektaler Karzinome - Tumorzentrum Regensburg.  Forum-DKG. 1999;  14 659-664
    PubMedGoogle Scholar
  • 93 Landheer M LEA, Therasse P, van de Velde C JH. The importance of quality assurance in surgical oncology in the treatment of colorectal cancer.  Surg Oncol Clin N Amer. 2001;  10 885-914
    PubMedGoogle Scholar
  • 94 Law W I, Chu K W, Ho J W, Chan C W. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision.  Am J Surg. 2000;  179 92-96
    CrossrefPubMedGoogle Scholar
  • 95 Leong A F. Selective total mesorectal excision for rectal cancer.  Dis Colon Rectum. 2000;  43 1237-1240
    CrossrefPubMedGoogle Scholar
  • 96 Lippert H, Gastinger I, Marusch F, Koch A. Qualitätssicherungsstudie „Rektumkarzinom” ab 1.1.2005.  Mitteilungen der Deutschen Gesellschaft für Chirurgie. 2005;  2 / 05 164-165
    PubMedGoogle Scholar
  • 97 Lopez-Kostner F, Lavery I C, Hool G R. et al . Total mesorectal excision is not necessary for cancers of the upper rectum.  Surg. 1998;  124 612-618
    CrossrefPubMedGoogle Scholar
  • 98 Mack L A, Temple W J. Education is the key to quality of surgery for rectal cancer.  Eur J Surg Oncol. 2005;  31 636-644
    CrossrefPubMedGoogle Scholar
  • 99 Marr R, Birbeck K, Garvican J. et al . The modern abdominoperineal excision: the next challenge after total mesorectal excision.  Ann Surg. 2005;  242 74-82
    CrossrefPubMedGoogle Scholar
  • 100 Martling A, Cedermark B, Johansson H. et al . The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer.  Br J Surg. 2002;  89 1008-1013
    CrossrefPubMedGoogle Scholar
  • 101 Martling A, Holm T, Bremmer S. et al . Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer.  Br J Surg. 2003;  90 1422-1426
    CrossrefPubMedGoogle Scholar
  • 102 Marusch F, Koch A, Schmidt U. et al . Prospektive Multizenterstudie „Kolon-/Rektumkarzinome” als flächendeckende Qualitätssicherung.  Chirurg. 2002;  73 138-146
    CrossrefPubMedGoogle Scholar
  • 103 Marusch F, Koch A, Schmidt U. et al . Stellenwert der Rektumexstirpation im Therapiekonzept des tief sitzenden Rektumkarzinoms.  Chirurg. 2003;  74 341-352
    CrossrefPubMedGoogle Scholar
  • 104 Matzel K E, Merkel S, Hohenberger W. Lokale Therapieprinzipien beim Rektumkarzinom.  Chirurg. 2003;  74 897-904
    CrossrefPubMedGoogle Scholar
  • 105 Maughan N J, Quirke P. Modern management of colorectal cancer - a pathologist's view.  Scand J Surg. 2003;  92 11-19
    PubMedGoogle Scholar
  • 106 Maurer C A, Renzulli P, Meyer J D, Büchler M W. Rektumkarzinom. Optimierung durch partielle oder totale Mesorektumentfernung.  Zbl Chir. 1999;  124 428-435
    PubMedGoogle Scholar
  • 107 Maurer C A, Renzulli P, Meyer J D, Büchler M W. Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery.  Br J Surg. 2001;  88 1501-1505
    PubMedGoogle Scholar
  • 108 Mawdsley S, Glynne-Jones R, Grainger J. et al . Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T 3-T 4 rectal cancer predict for 3-year disease-free survival.  Int J Radiat Oncol Biol Phys. 2005;  63 645-652
    CrossrefPubMedGoogle Scholar
  • 109 McCall J L, Cox M R, Wattchow D A. Analysis of local recurrence rates after surgery alone for rectal cancer.  Int J Colorect Dis. 1995;  10 126-132
    CrossrefPubMedGoogle Scholar
  • 110 MERCURY Study Group . Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study.  Brit Med J. 2006;  333 779-782
    CrossrefPubMedGoogle Scholar
  • 111 Merkel S, Kastl S, Hohenberger W. Qualitätsmanagement der Rektumkarzinom-Therapie: Ergebnisqualität. Abstract 12. Informationstagung Tumordokumentation 1999
    Google Scholar
  • 112 Merkel S, Mansmann U, Papadopoulos T. et al . The prognostic inhomogeneity of colorectal carcinomas stage III. A proposal for subdivision of stage III.  Cancer. 2001;  92 2754-2759
    CrossrefPubMedGoogle Scholar
  • 113 Merkel S, Meyer T, Göhl J, Hohenberger W. Late locoregional recurrence in rectal carcinoma.  Eur J Surg Oncol. 2002;  28 716-722
    CrossrefPubMedGoogle Scholar
  • 114 Merkel S, Mansmann U, Hohenberger W, Hermanek P. Einheitliche Berechnung von Lokalrezidivraten - Voraussetzung für das Qualitätsmanagement beim Rektumkarzinom.  Z ärztl Fortbild Qual Gesundhwes. 2006;  100 183-187
    PubMedGoogle Scholar
  • 115 Meyerhardt J A, Tepper J E, Niedzwiecki D. et al . Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: findings from the Intergroup 0114 Study.  J Clin Oncol. 2004;  22 166-174
    PubMedGoogle Scholar
  • 116 Michelassi F, Mhoon D A. Functional results following rectal surgery: A review. In: Soreide O, Norstein J (eds). Rectal cancer surgery. Optimisation - standardisation - documentation. Springer, Berlin, Heidelberg, New York 1997; 337-352
    Google Scholar
  • 117 Mörschel M, Heintz A, Dienes H-P, Junginger T. Lymphknotendissektion, Stadienverschiebung und perioperatives Risiko beim Rektumkarzinom.  Chirurg. 1996;  67 915-920
    PubMedGoogle Scholar
  • 118 Moutardier V, Tardat E, Giovannini M. et al . Long-term results of preoperative radiotherapy for 113 cases of uT3 and uT4 rectal cancer: a need for long-term follow-up.  Dis Colon Rectum. 2003;  46 1194-1199
    CrossrefPubMedGoogle Scholar
  • 119 Murty M, Enker W E, Martz J. Current status of total mesorectal excision and autonomic nerve preservation in rectal cancer.  Seminars Surg Oncol. 2000;  19 321-328
    CrossrefPubMedGoogle Scholar
  • 120 Nagtegaal I D, van de Velde C JH, van der Worp E. et al . Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control.  J Clin Oncol. 2002;  20 1729-1734
    CrossrefPubMedGoogle Scholar
  • 121 Nesbakken A, Nygaard K, Bull-Njaa T. et al . Bladder and sexual dysfunction after mesorectal excision for rectal cancer.  Br J Surg. 2000;  87 206-210
    CrossrefPubMedGoogle Scholar
  • 122 Nesbakken A, Nygaard K, Westerheim O. et al . Local recurrence after mesorectal excision for rectal cancer.  Eur J Surg Oncol. 2002;  28 126-134
    CrossrefPubMedGoogle Scholar
  • 123 Newland R C, Dent O F, Chapuis P H, Bokey E L. Clinicopathologically diagnosed residual tumor after resection for colorectal cancer.  Cancer. 1993;  72 1536-1542
    CrossrefPubMedGoogle Scholar
  • 124 Pahlman L, Gunnarsson U, Karlbom U. The influence on treatment outcome of structuring rectal cancer care.  Eur J Surg Oncol. 2005;  31 645-649
    CrossrefPubMedGoogle Scholar
  • 125 Peeters K C, Tollenaar R A, Marijnen C A. et al . Risk factors for anastomotic failure after total mesorectal excision of rectal cancer.  Br J Surg. 2005;  92 211-216
    CrossrefPubMedGoogle Scholar
  • 126 Peeters K CMJ, van de Velde C JH. Surgical quality assurance in rectal cancer treatment: the key to improved outcome.  Eur J Surg Oncol. 2005;  31 630-635
    CrossrefPubMedGoogle Scholar
  • 127 Petersen S, Freitag M, Hellmich G, Ludwig K. Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer.  Int J Colorect Dis. 1998;  13 160-163
    CrossrefPubMedGoogle Scholar
  • 128 Phillips R K, Hittinger R, Blesovsky L. Local recurrence following “curative” surgery for large bowel cancer. I. The overall picture.  Br J Surg. 1984;  71 12-16
    CrossrefPubMedGoogle Scholar
  • 129 Porter G, Soskolne C, Yakimets W. et al . Surgeon-related factors and outcome in rectal cancer.  Ann Surg. 1998;  227 157-167
    CrossrefPubMedGoogle Scholar
  • 130 Prentice R L. Surrogate endpoints: Definition and operational criteria.  Stat Med. 1989;  8 431-440
    PubMedGoogle Scholar
  • 131 Quirke P. Limitations of existing systems of staging for rectal cancer: the forgotten margin. In: Soreide O, Norstein J (eds). Rectal cancer surgery. Optimisation - standardisation - documentation. Springer, Berlin, Heidelberg, New York 1997; 63-81
    Google Scholar
  • 132 Quirke P. Training and quality assurance for rectal cancer: 20 years of data is enough.  Lancet Oncol. 2003;  4 695-702
    CrossrefPubMedGoogle Scholar
  • 133 Quirke P, Durdy P, Dixon M F, Williams N S. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumor spread and surgical excision.  Lancet. 1986;  ii 996-999
    CrossrefPubMedGoogle Scholar
  • 134 Quirke P, Dixon M P. The prediction of local recurrence in rectal adenocarcinoma by histopathological examination.  Int J Colorect Dis. 1988;  3 127-131
    CrossrefPubMedGoogle Scholar
  • 135 Ritz J -P, Buhr H J. Essenzielle chirurgische Standards beim Rektumkarzinom.  Chir Gastroenterol. 2005;  21 131-136
    CrossrefPubMedGoogle Scholar
  • 136 Rödel C, Sauer R. Neoadjuvant radiochemotherapy in rectal cancer: for which patients and tumor stages?. In: Wiegel T, Höcht S, Sternemann M et al. (eds). Controversies in gastrointestinal tumor therapy. Karger, Basel 2005; 13-23
    Google Scholar
  • 137 Rullier E, Laurent C, Garrelon J L. et al . Risk factors for anastomotic leakage after resection of rectal cancer.  Br J Surg. 1998;  85 355-358
    CrossrefPubMedGoogle Scholar
  • 138 Sargent D J, Wieand H S, Haller D G. et al . Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20 898 patients on 18 randomized trials.  J Clin Oncol. 2005;  23 8664-8670
    CrossrefPubMedGoogle Scholar
  • 139 Sauer R, Becker H, Hohenberger W. et al . Preoperative versus postoperative chemoradiotherapy for rectal cancer.  New Engl J Med. 2004;  351 1731-1740
    CrossrefPubMedGoogle Scholar
  • 140 Schmiegel W, Pox C, Adler G. et al . S 3-Leitlinienkonferenz „Kolorektales Karzinom”.  Z Gastroenterol. 2004;  42 1129-1177
    Article in Thieme ConnectPubMedGoogle Scholar
  • 141 Schneeweiss S, Sangha O. Leistungsvergleich in der Medizin. Bedarf, Anforderungen und Wege zur Akzeptanz.  Dtsch Med Wschr. 2001;  126 918-924
    PubMedGoogle Scholar
  • 142 Scott K WM, Grace R H. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance.  Br J Surg. 1989;  76 1165-1167
    PubMedGoogle Scholar
  • 143 Sebag-Montefiore D. Developments in the use of chemoradiotherapy in rectal cancer.  Colorect Disease. 2006;  8 (Suppl 3) 14-17
    PubMedGoogle Scholar
  • 144 Sebag-Montefiore G, Glynne-Jones R, Mortensen N. et al . Pooled analysis of outcome measure including the histopathological R 0 resection rate after preoperative chemoradiation for locally advanced rectal cancer.  Colorect Disease. 2005;  7 Suppl 1 7
    PubMedGoogle Scholar
  • 145 Sengupta A, Tjandra J J. Local excision of rectal cancer: what is the evidence?.  Dis Colon Rectum. 2001;  44 1345-1361
    CrossrefPubMedGoogle Scholar
  • 146 Sermier A, Gervaz P, Egger J. et al . Lymph node retrieval in abdomino-perineal surgical specimen is radiation-time dependent.  World J Surg Oncol. 2006;  4 (e-published) 29
    CrossrefPubMedGoogle Scholar
  • 147 Simunovic M, To T, Baxter N. et al . Hospital procedure volume and teaching status do not influence treatment and outcome measure of rectal surgery in a large general population.  J Gastrointest Surg. 2000;  4 324-330
    CrossrefPubMedGoogle Scholar
  • 148 Singh S, Morgan M BF, Broughton M. et al . A 10-year prospective audit of outcome of surgical treatment for colorectal carcinoma.  Br J Surg. 1995;  82 1486-1490
    PubMedGoogle Scholar
  • 149 Sinn H P, Hermanek P, Wagner G, Wittekind C. Organspezifische Tumordokumentation. 3. Aufl. Empfehlungen zu Dokumentationsinhalten für Studien. Internetfassung („OTD-3-Internet”). Deutsche Krebsgesellschaft, Frankfurt/Main. http://otd.tuxcomp.org 2003 ff
    Google Scholar
  • 150 Slanetz C A jr. The effect of inadvertent intraoperative perforation on survival and recurrence of colorectal cancer.  Dis Colon Rectum. 1984;  27 792-797
    PubMedGoogle Scholar
  • 151 Soreide O, Norstein J, Fielding L P, Silen W. International standardization and documentation of the treatment of rectal cancer. In: Soreide O, Norstein J (eds). Rectal cancer surgery. Optimisation - standardisation - documentation. Springer, Berlin, Heidelberg, New York 1997; 405-445
    Google Scholar
  • 152 Staib L, Link K H, Blatz A, Beger H G. Surgery of colorectal cancer: surgical morbidity and five-and ten-year results in 2400 patients - monoinstitutional experience.  World J Surg. 2002;  26 59-66
    CrossrefPubMedGoogle Scholar
  • 153 Stocchi L, Nelson H, Sargent D J. et al . Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report.  J Clin Oncol. 2001;  19 3895-3902
    PubMedGoogle Scholar
  • 154 Swedish Rectal Cancer Trial . Improved survival with preoperative radiotherapy in resectable rectal cancer.  New Engl J Med. 1997;  336 980-987 ,  Erratum 336: 1539
    CrossrefPubMedGoogle Scholar
  • 155 Tekkis P P, Heriot A G, Smith J. et al. on behalf of the Association of Coloproctology of Great Britain and Ireland . Comparison of circumferential margin involvement between restorative and non-restorative resections for rectal cancer.  Colorect Dis. 2005;  7 369-374
    CrossrefPubMedGoogle Scholar
  • 156 Hermanek P, Henson D E, Hutter R VP, Sobin L H. (eds) .TNM Supplement 1993. A commentary on uniform use. Springer, Berlin, Heidelberg, New York
    Google Scholar
  • 157 Sobin L H, Wittekind C. (eds) .TNM classification of malignant tumours. 6th ed. John Wiley & Sons, New York 2002
    Google Scholar
  • 158 Wittekind C, Greene F L, Henson D E, Hutter R VP, Sobin L H. (eds) .TNM Supplement. 3rd ed. A commentary on uniform use. John Wiley & Sons, New York 2003
    Google Scholar
  • 159 Vernava A M 3rd , Moran M, Rothenberger D A, Wong W D. A prospective evaluation of distal margins in carcinoma of the rectum.  Surg Gyn Obstet. 1992;  175 333-336
    PubMedGoogle Scholar
  • 160 Vignali A, Fazio V W, Lavery I C. et al . Factors with the occurence of leaks in stapled rectal anastomoses: a review of 1014 patients.  J Am Coll Surg. 1997;  185 105-113
    CrossrefPubMedGoogle Scholar
  • 161 Wibe A, Rendedal P R, Svensson E. et al. on behalf of the Norwegian Rectal Cancer Group . Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer.  Br J Surg. 2002;  89 327-334
    CrossrefPubMedGoogle Scholar
  • 162 Wibe A, Carlsen E, Dahl O. et al . Nationwide quality assurance of rectal cancer treatment.  Colorectal Disease. 2006;  8 224-229
    CrossrefPubMedGoogle Scholar
  • 163 Wille-Jörgensen P, Guenaga K F, Castro A A, Matos D. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review.  Dis Colon Rectum. 2003;  46 1013-1020
    CrossrefPubMedGoogle Scholar
  • 164 Willeke F, Horisberger K, Post S. Neoadjuvante Therapie beim Rektumkarzinom: Auf dem Weg zur individuellen Therapie.  Z Gastroenterol. 2006;  44 1053-1063
    Article in Thieme ConnectPubMedGoogle Scholar
  • 165 Winde G, Nottberg H, Keller F. et al . Surgical cure for early rectal carcinomas (T 1). Transanal endoscopic microsurgery vs. anterior resection.  Dis Colon Rectum. 1996;  39 969-976
    CrossrefPubMedGoogle Scholar
  • 166 Wittekind C. Pathologiebefunde in der RCT-Studie 95 - Vorläufige kritische Wertung. Vortrag TME Kolloquium MERCURY-Studie, Berlin 1.12.2002
    Google Scholar
  • 167 Wong J H, Severino R, Hannebier M P. et al . Number of nodes examined and staging accuracy in colorectal carcinoma.  J Clin Oncol. 1999;  17 2896-2900
    PubMedGoogle Scholar
  • 168 Zaheer S, Pemberton J H, Farouk R. et al . Surgical treatment of adenocarcinoma of the rectum.  Ann Surg. 1998;  227 800-811
    CrossrefPubMedGoogle Scholar
  • 169 Zirngibl H, Husemann B, Hermanek P. Intraoperative spillage of tumor cells in surgery for rectal cancer.  Dis Colon Rectum. 1990;  33 610-614
    CrossrefPubMedGoogle Scholar
  • 170 Zorn U, Ollenschläger G. Qualitätsbestimmung in der medizinischen Versorgung - ein universelles Entwicklungsschema für Qualitätsindikatoren.  Z ärztl Fortbild Qualsich. 1999;  93 123-128
    PubMedGoogle Scholar

Prof. Dr. Dr. h. c. P. Hermanek

Chirurgische Klinik und Poliklinik der Universität Erlangen-Nürnberg

Krankenhausstraße 12

91054 Erlangen

Phone: 0 91 31/8 53 32 69

Fax: 0 91 31/85 33 46 75