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Endoskopie heute 2015; 28(02): 165-173
DOI: 10.1055/s-0035-1553810
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Chronisch entzündliche Darmerkrankungen – Aktuelle Aspekte

Chronic Inflammatory Bowel Disease – Recent aspects
M. Vieth
1   Institut für Pathologie, Klinikum Bayreuth, Bayreuth
,
T. Rath
2   Medizinische Klinik 1, Universität Erlangen-Nürnberg, Erlangen
,
E. C. Bästlein
3   Magen Darm Zentrum, Gastroenterologie, Köln
,
H. Neumann
2   Medizinische Klinik 1, Universität Erlangen-Nürnberg, Erlangen
› Author Affiliations
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Publication History

Publication Date:
14 December 2015 (online)

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Zusammenfassung

Die intestinale Entzündung nimmt bei der Entwicklung von Karzinomen bei chronisch entzündlichen Darmerkrankungen (CEDE) eine herausragende Bedeutung ein. Aufgrund des engen Zusammenhangs zwischen dem Ausmaß und der Aktivität der intestinalen Inflammation und dem Auftreten von kolitisassoziierten Karzinomen, zielen derzeitige Behandlungsschemata darauf ab, die mukosale Inflammation zu minimieren oder gar zur Abheilung, dem sogenannten mucosal healing, zu bringen. Die gastrointestinale Endoskopie und Histopathologie spielen eine zentrale Rolle nicht nur für die Diagnose von kolitisassoziierten Neoplasien, sondern auch für die erfolgreiche endoskopische Entfernung und müssen folglich klar definierten Kriterien unterliegen und folgen, um einen hohen Qualitätsmaßstab zu gewährleisten. In unserer Institution sind über 90 % aller Karzinome bei CDE Fälle von Colitis ulcerosa. Daher konzentrieren wir uns im vorliegenden Manuskripts auf die Colitis ulcerosa und Neoplasien, welche mit der Colitis ulcerosa assoziiert sind. Es ist bekannt, dass außerhalb von spezialisierten Zentren auch Teilkolektomien anstatt von Proktokolektomien beim Nachweis von kolitisassoziierten Karzinomen durchgeführt werden. Unsere retrospektiven Daten zeigen, dass die Teilkolektomie ein höheres Risiko für Rezidive von Lymphknotenmetastasen birgt, ebenso auch für metachrone Läsionen. Obwohl die Überlebensraten zwischen Teil- und Proktokolektomie nahezu vergleichbar sind, stellen vollständige Proktokolektomien noch immer die Behandlung der Wahl für Karzinome bei Colitis ulcerosa dar.

Abstract

Inflammation plays a huge role in carcinogenesis in inflammatory bowel disease (IBD). Due to the close relation of extent and degree of inflammation in colitis-associated carcinomas modern treatment strategies seek for minimizing mucosal inflammation or even mucosal healing. Gastrointestinal endoscopy and histopathology play a pivotal role not only for diagnostics but also for endoscopic removal. Clear cut definitions of criteria are mandatory to ensure a high quality setup. At our institution more than 90 % of all carcinomas in IBD develop in ulcerative colitis. Therefore, we will focus on ulcerative colitis and ulcerative colitis-associated carcinomas in the present manuscript. It is known that aside from specialized centers that instead of performing proctocolectomies partial colectomies are carried out in case of colitis-associated carcinomas. Our retrospective data show that partial colectomies bear a higher risk for relapses on base of lymph node metastases and metachronous lesions as well. Survival rates of partial and complete colectomies are comparable but proctocolectomies are still the therapy of choice for carcinomas in ulcerative colitis.

Schlüsselwörter

Colitis ulcerosa - Morbus Crohn - Histologie Karzinom - Behandlung

Key words

ulcerative colitis - Crohn’s disease - histology carcinoma - treatment
 

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