Subscribe to RSS
DOI: 10.1055/a-2256-6809
State of the Art Rektumchirurgie
State of the Art Rectal SurgeryZusammenfassung
Die multimodale Therapie des Rektumkarzinoms hat sich über die letzte Dekade erheblich differenziert je nach Charakteristika des Tumors und Gegebenheiten des Patienten. Die Operation stellt weiterhin eine wichtige Säule der Therapie dar, deren Qualität von prognostischer Relevanz für betroffene Patienten ist. Diese Übersicht gibt einen aktuellen Überblick zur Indikation der verschiedenen chirurgischen Verfahren, aktuellen Entwicklungen zum perioperativen Management sowie zum Zeitpunkt einer Operation.
Abstract
The multimodal treatment of rectal cancer has differentiated considerably over the last decade depending on the characteristics of the tumor and the patient’s circumstances. Surgery continues to be an important pillar of therapy, the quality of which is of prognostic relevance for affected patients. This review provides an up-to-date overview of the indications for the various surgical procedures, current developments in perioperative management and the timing of surgery.
Publication History
Received: 04 December 2023
Accepted after revision: 30 January 2024
Article published online:
05 March 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Deschner BW, VanderWalde NA, Grothey A. et al. Evolution and Current Status of the Multidisciplinary Management of Locally Advanced Rectal Cancer. JCO Oncol Pract 2021; 17: 383-402 DOI: 10.1200/OP.20.00885. (PMID: 33881906)
- 2 Ghadimi M, Rödel C, Hofheinz R. et al. Multimodal Treatment of Rectal Cancer. Dtsch Arztebl Int 2022; 119: 570-580 DOI: 10.3238/arztebl.m2022.0254. (PMID: 35791271)
- 3 Perea J, Gallagher P, Delores A. Lights and shadows in the early-onset colorectal cancer management and research: An integrative perspective – Physician scientist with patient advocates. Best Pract Res Clin Gastroenterol 2023; 66: 101851 DOI: 10.1016/j.bpg.2023.101851. (PMID: 37852716)
- 4 Rectal Cancer: Chemo Matches Radiation. Cancer Discov [Anonym]. 2023; 13: 1753 DOI: 10.1158/2159-8290.CD-NB2023-0046.
- 5 Motamedi MAK, Mak NT, Brown CJ. et al. , Local versus radical surgery for early rectal cancer with or without neoadjuvant or adjuvant therapy. Cochrane Database Syst Rev 2023; 6: CD002198 DOI: 10.1002/14651858.CD002198.pub3. (PMID: 32527117)
- 6 Hall WA, Smith JJ. Achieving a Cure Without Total Mesorectal Excision in Rectal Adenocarcinoma. J Clin Oncol 2023; 41: 173-180 DOI: 10.1200/JCO.22.01812. (PMID: 36332177)
- 7 Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF. S3-Leitlinie Kolorektales Karzinom, Langversion 2.1, 2019, AWMF-Registernummer: 021/007OL. Accessed February 06, 2024 at: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Kolorektales_Karzinom/Version_2/LL_KRK_Langversion_2.1.pdf
- 8 Fields AC, Lu P, Hu F. et al. Lymph Node Positivity in T1/T2 Rectal Cancer: a Word of Caution in an Era of Increased Incidence and Changing Biology for Rectal Cancer. J Gastrointest Surg 2021; 25: 1029-1035 DOI: 10.1007/s11605-020-04580-z. (PMID: 32246393)
- 9 Kobayashi H, Mochizuki H, Kato T. et al. Is total mesorectal excision always necessary for T1-T2 lower rectal cancer?. Ann Surg Oncol 2010; 17: 973-980 DOI: 10.1245/s10434-009-0849-y.
- 10 Gilbert A, Homer V, Brock K. et al. Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuitable for total mesorectal excision. Lancet Healthy Longev 2022; 3: e825-e838 DOI: 10.1016/S2666-7568(22)00239-2.
- 11 Serra-Aracil X, Pericay C, Badia-Closa J. et al. Short-term outcomes of chemoradiotherapy and local excision versus total mesorectal excision in T2-T3ab,N0,M0 rectal cancer: a multicentre randomised, controlled, phase III trial (the TAU-TEM study). Ann Oncol 2023; 34: 78-90 DOI: 10.1016/j.annonc.2022.09.160. (PMID: 36220461)
- 12 Arbeitsgemeinschaft Internistische Onkologie (AIO) in der Deutschen Krebsgesellschaft e. V. Statement der AIO-KRK Leitgruppe gemeinsam mit der ARO und ACO zu den beim ASCO 2023 vorgestellten Ergebnissen der amerikanischen PROSPECT-Studie für eine Subgruppe von Patient*innen mit Rektumkarzinom. Accessed February 06, 2024 at: https://www.aio-portal.de/stellungnahmen.html
- 13 Carbone F, Petz W, Borin S. et al. Tumour-specific mesorectal excision for rectal cancer: Systematic review and meta-analysis of oncological and functional outcomes. Eur J Surg Oncol 2023; 49: 107069 DOI: 10.1016/j.ejso.2023.107069. (PMID: 37708660)
- 14 Schrag D, Shi Q, Weiser MR. et al. Preoperative Treatment of Locally Advanced Rectal Cancer. N Engl J Med 2023; 389: 322-334 DOI: 10.1056/NEJMoa2303269. (PMID: 37272534)
- 15 Fokas E, Rödel C. [Preoperative treatment of rectal cancer-Critical comments on the US-American PROSPECT trial]. Strahlenther Onkol 2023; 199: 781-783 DOI: 10.1007/s00066-023-02116-3. (PMID: 37429948)
- 16 Sun Myint A, Rao C, Barbet N. et al. The safety and efficacy of total mesorectal excision (TME) surgery following dose-escalation: Surgical outcomes from the organ preservation in early rectal adenocarcinoma (OPERA) trial, a European multicentre phase 3 randomised trial (NCT02505750). Colorectal Dis 2023; 25: 2160-2169 DOI: 10.1111/codi.16773.
- 17 Ludford K, Ho WJ, Thomas JV. et al. Neoadjuvant Pembrolizumab in Localized Microsatellite Instability High/Deficient Mismatch Repair Solid Tumors. J Clin Oncol 2023; 41: 2181-2190 DOI: 10.1200/JCO.22.01351. (PMID: 36623241)
- 18 Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary?. Langenbecks Arch Surg 2015; 400: 145-152 DOI: 10.1007/s00423-015-1275-1. (PMID: 25633276)
- 19 Hüttner FJ, Probst P, Mihaljevic A. et al. Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial. BMJ Open 2020; 10: e038930 DOI: 10.1136/bmjopen-2020-038930. (PMID: 33060088)
- 20 Johnston WF. Coloanal Anastomosis. Clin Colon Rectal Surg 2023; 36: 29-36 DOI: 10.1055/s-0042-1757563. (PMID: 36619278)
- 21 Benson AB, Venook AP, Al-Hawary MM. et al. Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20: 1139-1167 DOI: 10.6004/jnccn.2022.0051. (PMID: 36240850)
- 22 Maguire B, Clancy C, Connelly TM. et al. Quality of life meta-analysis following coloanal anastomosis versus abdominoperineal resection for low rectal cancer. Colorectal Dis 2022; 24: 811-820 DOI: 10.1111/codi.16099. (PMID: 35194919)
- 23 Saito N, Ito M, Kobayashi A. et al. [Sphincter-saving resection for low rectal cancer]. Nihon Geka Gakkai Zasshi 2011; 112: 318-324 (PMID: 21941822)
- 24 Liu H, Zeng Z, Zhang H. et al. Morbidity, Mortality, and Pathologic Outcomes of Transanal Versus Laparoscopic Total Mesorectal Excision for Rectal Cancer Short-term Outcomes From a Multicenter Randomized Controlled Trial. Ann Surg 2023; 277: 1-6 DOI: 10.1097/SLA.0000000000005523.
- 25 Grade M, Ghadimi M. Rektumkarzinom: Radikale operative Therapie. In: Kreis M, Bartsch DK, Lang H. Viszeral- und Allgemeinchirurgie. Berlin, Heidelberg: Springer; 2021: 1-12 DOI: 10.1007/978-3-662-61724-3
- 26 Riva CG, Kelly ME, Vitellaro M. et al. A comparison of surgical techniques for perineal wound closure following perineal excision: a systematic review and network meta-analysis. Tech Coloproctol 2023; 27: 1351-1366 DOI: 10.1007/s10151-023-02868-1. (PMID: 37843643)
- 27 Loria A, Tejani MA, Temple LK. et al. Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006–2020. JAMA Oncol 2024; 10: 79-86 DOI: 10.1001/jamaoncol.2023.4845.
- 28 Verheij FS, Omer DM, Williams H. et al. Long-Term Results of Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy: The Randomized Phase II OPRA Trial. J Clin Oncol 2023; DOI: 10.1200/JCO2301208.
- 29 Felder SI, Garcia-Aguilar J. ASO Author Reflections: Endoscopic Rectal Cancer Response to Neoadjuvant Therapy: Qualitative or Quantitative Interpretation?. Ann Surg Oncol 2021; 28: 5224-5225 DOI: 10.1245/s10434-021-09895-y. (PMID: 33796996)
- 30 Fokas E, Appelt A, Glynne-Jones R. et al. International consensus recommendations on key outcome measures for organ preservation after (chemo)radiotherapy in patients with rectal cancer. Nat Rev Clin Oncol 2021; 18: 805-816 DOI: 10.1038/s41571-021-00538-5.
- 31 Diefenhardt M, Martin D, Fleischmann M. et al. Overall Survival After Treatment Failure Among Patients With Rectal Cancer. JAMA Netw Open 2023; 6: e2340256 DOI: 10.1001/jamanetworkopen.2023.40256.
- 32 Bogner A, Fritzmann J, Müssle B. et al. Pelvic exenteration for colorectal and non-colorectal cancer: a comparison of perioperative and oncological outcome. Int J Colorectal Dis 2021; 36: 1701-1710 DOI: 10.1007/s00384-021-03893-y.
- 33 Gould LE, Pring ET, Moorghen M. et al. Pathological determinants of outcome following resection of locally advanced or locally recurrent rectal cancer. Eur J Surg Oncol 2023; 49: 106971 DOI: 10.1016/j.ejso.2023.06.023. (PMID: 35781038)
- 34 van Kessel CS, Waller J, Steffens D. et al. Improving Surgical Outcomes in Pelvic Exenteration Surgery: Comparison of Prone Sacrectomy With Anterior Cortical Sacrectomy Techniques. Ann Surg 2023; 278: 945-953 DOI: 10.1097/SLA.0000000000006040.
- 35 Leitlinienprogramm Onkologie, Deutsche Krebshilfe, Deutsche Krebsgesellschaft, AWMF. Konsultationsfassung Perioperatives Management bei gastrointestinalen Tumoren (POMGAT). Version 1.01 – Juni 2023. AWMF-Registerummer: 088–010OL. Accessed February 06, 2024 at: https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/LL_POMGAT_Langversion_1.01.pdf
- 36 Willis MA, Schwenk W, Post S. et al. [Background, Necessity and Methodology of the S3 Guideline "Perioperative Management of Gastrointestinal Tumours (POMGAT)"]. Zentralbl Chir 2021; 146: 241-248 DOI: 10.1055/a-1481-9394. (PMID: 34154005)
- 37 Watanabe J, Takemasa I, Kotake M. et al. Blood Perfusion Assessment by Indocyanine Green Fluorescence Imaging for Minimally Invasive Rectal Cancer Surgery (EssentiAL trial): A Randomized Clinical Trial. Ann Surg 2023; 278: e688-e694 DOI: 10.1097/SLA.0000000000005907. (PMID: 37218517)
- 38 Willis MA, Keller PS, Sommer N. et al. Adherence to fast track measures in colorectal surgery-a survey among German and Austrian surgeons. Int J Colorectal Dis 2023; 38: 80 DOI: 10.1007/s00384-023-04379-9.
- 39 Willis MA, Toews I, Soltau SL. et al. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database Syst Rev 2023; 2: CD014909 DOI: 10.1002/14651858.CD014909.pub2.
- 40 Kang SB, Park JW, Jeong SY. et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 2010; 11: 637-645 DOI: 10.1016/S1470-2045(10)70131-5. (PMID: 20610322)
- 41 Jeong SY, Park JW, Nam BH. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 2014; 15: 767-774 DOI: 10.1016/S1470-2045(14)70205-0. (PMID: 24837215)
- 42 Park JW, Kang SB, Hao J. et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial. Lancet Gastroenterol Hepatol 2021; 6: 569-577 DOI: 10.1016/S2468-1253(21)00094-7. (PMID: 33894918)
- 43 Young M, Pigazzi A. Total mesorectal excision: open, laparoscopic or robotic. Recent Results Cancer Res 2014; 203: 47-55 DOI: 10.1007/978-3-319-08060-4_6. (PMID: 25102999)
- 44 Bonjer HJ, Deijen CL, Abis GA. et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015; 372: 1324-1332 DOI: 10.1056/NEJMoa1414882. (PMID: 25830422)
- 45 Fleshman J, Branda M, Sargent DJ. et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA 2015; 314: 1346-1355 DOI: 10.1001/jama.2015.10529. (PMID: 26441179)
- 46 Fleshman J, Branda ME, Sargent DJ. et al. Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial. Ann Surg 2019; 269: 589-595 DOI: 10.1097/SLA.0000000000003002.
- 47 Stevenson ARL, Solomon MJ, Brown CSB. et al. Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Ann Surg 2019; 269: 596-602 DOI: 10.1097/SLA.0000000000003021. (PMID: 30247332)
- 48 Stevenson ARL, Solomon MJ, Lumley JW. et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA 2015; 314: 1356-1363 DOI: 10.1001/jama.2015.12009. (PMID: 26441180)
- 49 Andersson J, Angenete E, Gellerstedt M. et al. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg 2013; 100: 941-949 DOI: 10.1002/bjs.9144. (PMID: 23640671)
- 50 Andersson J, Abis G, Gellerstedt M. et al. Patient-reported genitourinary dysfunction after laparoscopic and open rectal cancer surgery in a randomized trial (COLOR II). Br J Surg 2014; 101: 1272-1279 DOI: 10.1002/bjs.9550. (PMID: 24924798)
- 51 Mercieca-Bebber R, Eggins R, Brown K. et al. Patient-Reported Bowel, Urinary, and Sexual Outcomes After Laparoscopic-Assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial (ALaCart). Ann Surg 2023; 277: 449-455 DOI: 10.1097/SLA.0000000000005412. (PMID: 35166265)
- 52 Jayne D, Pigazzi A, Marshall H. et al. Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial. JAMA 2017; 318: 1569-1580 DOI: 10.1001/jama.2017.7219.
- 53 Bolton WS, Chapman SJ, Corrigan N. et al. The Incidence of Low Anterior Resection Syndrome as Assessed in an International Randomized Controlled Trial (MRC/NIHR ROLARR). Ann Surg 2021; 274: e1223-e1229 DOI: 10.1097/SLA.0000000000003806. (PMID: 32097165)
- 54 Willis MA, Soltau SLV, van Beekum C. et al. [Robot-assisted rectal resections-Scoping review for level 1a evidence and retrospective analysis of in-clinic data]. Chirurgie (Heidelb) 2023; 94: 138-146 DOI: 10.1007/s00104-022-01774-w. (PMID: 36449038)
- 55 Muttillo EM, La Franca A, Coppola A. et al. Low Anterior Resection Syndrome (LARS) after Surgery for Rectal Cancer: An Inevitable Price to Pay for Survival, or a Preventable Complication?. J Clin Med 2023; 12: 5962 DOI: 10.3390/jcm12185962. (PMID: 37762904)
- 56 Hashempour MR, Moradi M, Oroomi RG. et al. Assessing the role of anastomotic level in low anterior resection (LAR) surgery among rectal cancer patients in the development of LAR syndrome: a systematic review study. BMC Surg 2023; 23: 263 DOI: 10.1186/s12893-023-02166-5.
- 57 Hernandez MC, Wong P, Melstrom K. Low anterior resection syndrome. J Surg Oncol 2023; 127: 1271-1276 DOI: 10.1002/jso.27261. (PMID: 37222699)
- 58 Grumann MM, Noack EM, Hoffmann IA. et al. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 2001; 233: 149-156 DOI: 10.1097/00000658-200102000-00001. (PMID: 11176118)
- 59 Schmitt J, Klinkhammer-Schalke M, Bierbaum V. et al. Initial Cancer Treatment in Certified Versus Non-Certified Hospitals. Dtsch Arztebl Int 2023; 120: 647-654 DOI: 10.3238/arztebl.m2023.0169. (PMID: 37583089)
- 60 Völkel V, Gerken M, Kleihues-van Tol K. et al. Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival. Cancers (Basel) 2023; 15: 4568 DOI: 10.3390/cancers15184568.
- 61 Rottoli M, Spinelli A, Pellino G. et al. Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study. Br J Surg 2024; 111: znad373 DOI: 10.1093/bjs/znad373. (PMID: 37963162)
- 62 Sprenger T, Beißbarth T, Sauer R. et al. The long-term influence of hospital and surgeon volume on local control and survival in the randomized German Rectal Cancer Trial CAO/ARO/AIO-94. Surg Oncol 2020; 35: 200-205 DOI: 10.1016/j.suronc.2020.08.021.