Laparoskopische Resektion des Rektumkarzinoms

Zusammenfassung

Für das Kolonkarzinom konnte bereits gezeigt werden, dass die laparoskopische Resektion mit den gleichen frühpostoperativen und onkologischen Langzeit-Ergebnissen wie nach offener Resektion möglich ist (Evidenz-Level I a). Für das Rektumkarzinom liegen mit hoher Evidenz bisher nur Daten zu den frühpostoperativen Ergebnissen vor. Dabei lassen sich keine relevanten Vorteile nach laparoskopischer versus offener Resektion erkennen. Ebenso ist heute unbestritten, dass bei geeigneter Patientenselektion die onkologisch adäquate Resektion von Rektumkarzinomen auch via laparoskopischem Zugang möglich ist. Zu den onkologischen Langzeitergebnissen gibt es gegenwärtig jedoch keine Daten mit I a-Evidenz. Es liegen jedoch Daten aus prospektiv-randomisierten Studien mit kleiner Fallzahl sowie größere Fallserien aus spezialisierten Zentren vor, die den offenen Resektionen vergleichbare Ergebnisse nach laparoskopischer Resektion zeigen. Eine abschließende Bewertung erlauben diese Daten jedoch nicht. Neben einer Übersicht zu den aktuellen Literaturergebnissen, die die laparoskopische Resektion beim Rektumkarzinom bewerten, werden Ergebnisse aus der bundesweiten Qualitätssicherungsstudie „Kolon/Rektum-Karzinom (Primärtumor)” vorgestellt, die die aktuelle Situation zur laparoskopischen Rektumkarzinom-Resektion im Vergleich zur offenen Resektion vergleichen.

Abstract

In colon cancer, it has been demonstrated that laparoscopic resection can achieve comparable early postoperative and oncological long-term results as with open resection (evidence level, I a). In rectal cancer, there are only data available on early postoperative results with a high level of evidence but no results on the long-term outcome. There is no substantial advantage comparing early postoperative results after laparoscopic versus open rectal cancer resection. Furthermore, it is undoubted that the oncologically adequate resection of rectal cancer is also feasible and suitable via the laparoscopic approach including an appropriate patient selection. Preliminary results obtained in prospective randomized studies with a low case number and in more extensive case series at various surgical centers have been reported on a comparable outcome of open and laparoscopic resections. However, a concluding assessment appears not to be possible on the basis of these limited data. In addition to a short review on the currently available results on this topic from the literature, results of the Germany-wide Study on Quality Control “Colon/Rectum Carcinoma (Primary Tumor)” with a representative case number and a multicenter setting are described comparing laparoscopic and open resection of rectal cancer at present.

Rektumkarziom - laparoskopische Resektion - früh-postoperative Ergebnisse - Langzeitergebnisse

Rectal cancer - laparoscopic resection - early postoperative results - oncological long-term outcome

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