Stellenwert der lokalen Exzision von Rektumkarzinomen

Zusammenfassung

Die lokale Exzision von frühen Rektumkarzinomen stellt eine etablierte, onkologisch adäquate Therapie dar. Dennoch weisen die Lokalrezidivraten eine hohe Spannbreite auf und es bestehen unterschiedliche Therapiekonzepte. Unklar ist in diesem Zusammenhang die Indikation zur lokalen Exzision von Rektumkarzinomen, d. h. ob neben T1-„low-risk”-Karzinomen auch weiter fortgeschrittenere Tumoren (T2) lokalchirurgisch behandelt werden können. Ziel dieser Arbeit ist, die Lokalrezidivraten zu analysieren und die Bedeutung einer multimodalen Therapie aufzuzeigen.

Abstract

Local excision of early rectal cancer represents an established oncologically adequate therapy. However, local recurrence rates show a large variability und different therapeutic concepts exist. In this context, the indication for local excision of rectal cancer is unclear, e. g. whether in addition to “low-risk” Th1 carcinomas more advanced tumors (T2) can also be treated with local surgery. The aim of this review was to analyze local recurrence rates and to highlight the relevance of multimodal therapy.

Rektumkarzinom - lokale Exzision - frühe Nachoperation vs. Rezidivoperation - adjuvante vs. neoadjuvante Radiochemotherapie

rectal cancer - local excisison - immediate vs. salvage reoperatrion - adjuvant vs. neoadjuvant chemoradiation

Literatur

• 1 Borschitz T, Heintz A, Junginger T. The influence of histopathologic criteria on the long-term prognosis of locally excised pT1 rectal carcinomas: Results of local excision (transanal endoscopic microsurgery) and immediate reoperation.  Dis Colon Rectum. 2006;  , [Epub ahead of print]
• 2 Borschitz T, Junginger T. Value of local surgical therapy of rectal cancer. A literature analysis.  Zentralbl Chir. 2003;  128 1066-1074
• 3 Duek S D, Krausz M M, Hershko D D. Transanal endoscopic microsurgery for rectal cancer.  Isr Med Assoc J. 2005;  7 435-438
• 4 Faivre J, Chaume J-C, Pigot F, Trojani M, Bonichon F. Transanal electroresection of small rectal cancer: a sole treatment?.  Dis Colon Rectum. 1996;  39 270-278
• 5 Ganai S, Kanumuri P, Rao R S, Alexander A I. Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers.  Ann Surg Oncol. 2006;  13 547-556
• 6 Gonzalez Q H, Heslin M J, Shore G, Vickers S M, Urist M M, Bland K I. Results of long-term follow-up for transanal excision for rectal cancer.  Am Surg. 2003;  69 675-678
• 7 Hahnloser D, Wolff B G, Larson D W, Ping J, Nivatvongs S. Immediate radial resection after local excision of rectal cancer: An oncologic compromise?.  Dis Colon Rectum. 2005;  48 429-437
• 8 Kim D G, Madoff R D. Transanal treatment of rectal cancer: ablative methods and open resection.  Semin Surg Oncol. 1998;  15 101-113
• 9 Koscinski T, Malinger S, Drews M. Local excision of rectal carcinoma not exceeding the muscularis layer.  Colorectal Dis. 2003;  5 159-163
• 10 Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi B M, Fuzesi L, Becker H. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection.  Int J Colorectal Dis. 2003;  18 222-229
• 11 Lee W, Lee D, Choi S, Chun H. Related Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer.  Surg Endosc. 2003;  17 1283-1287
• 12 Marks J H, Marchionni C, Marks G J. Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer.  Surg Endosc. 2003;  17 1114-1117
• 13 Mentges B, Buess G, Effinger G, Manncke K, Becker H D. Indications and results of local treatment of rectal cancer.  Br J Surg. 1997;  84 348-351
• 14 Middleton P F, Sutherland L M, Maddern G J. Transanal endoscopic microsurgery: a systematic review.  Dis Colon Rectum. 2005;  48 270-284
• 15 Nakagoe T, Sawai T, Tsuji T. et al . Local rectal tumor resection results: gasless, video-endoscopic transanal excision versus the conventional posterior approach.  World J Surg. 2003;  27 197-202
• 16 Schafer H, Baldus S E, Gasper F, Holscher A H. Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery.  Chirurg. 2005;  76 379-384
• 17 Sengupta S, Tjandra J J. Local excision of rectal cancer: what is the evidence?.  Dis Colon Rectum. 2001;  44 1345-1361
• 18 Sharma A, Hartley J, Monson J RT. Local excision of rectal tumours.  Surg Onco. 2003;  12 51-61
• 19 Slisow W, Moesta K T, Schlag P M. Local excision of rectal cancer through windowed specula: long-term results.  Recent Result Cancer Res. 1998;  146 114-123
• 20 Suzuki H, Furukawa K, Kan H, Tsuruta H, Matsumoto S, Akiya Y, Shinji S, Tajiri T. The role of transanal endoscopic microsurgery for rectal tumors.  J Nippon Med Sch. 2005;  72 278-284
• 21 Winde G, Nottberg H, Keller R, Schmid K W, Bünte H. Surgical cure for early rectal carcinomas (T1): transanal endoscopic microsurgery vs. anterior resection.  Dis Colon Rectum. 1996;  39 969-976
• 22 Bentrem D J, Okabe S, Wong W D, Guillem J G, Weiser M R, Temple L K, Ben-Porat L S, Minsky B D, Cohen A M, Paty P B. T1 adenocarcinoma of the rectum: transanal excision or radical surgery.  Ann Surg. 2005;  242 472-477 ,  discussion 477-479
• 23 Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff R D, Rothenberg D A. Local excision of rectal cancer without adjuvant therapy a word of caution.  Ann Surg. 2000;  231 345-351
• 24 Gopaul D, Belliveau P, Vuong T, Trudel J, Vasilevsky C A, Corns R, Gordon P H. Outcome of local excision of rectal carcinoma.  Dis Colon Rectum. 2004;  47 1780-1788
• 25 Endreseth B H, Myrvold H E, Romundstad P, Hestvik U E, Bjerkeset T, Wibe A. The Norwegian Rectal Cancer Group . Transanal excision vs. major surgery for T1 rectal cancer.  Dis Colon Rectum. 2005;  48 1380-1388
• 26 Lamont J P, McCarty T M, Digan R D, Jacobson R, Tulanon P, Lichliter W E. Should locally excised T1 rectal cancer receive adjuvant chemoradiation?.  Am J Surg. 2000;  180 402-406
• 27 Madbouly K M, Remzi F H, Erkek B A, Senagore A J, Baeslach C M, Khandwala F, Fazio V W, Lavery I C. Recurrence after transanal excision of T1 rectal cancer: should we be concerned?.  Dis Colon Rectum. 2005;  48 711-719 ,  discussion 719-721
• 28 Mellgren A, Sirivong P, Rothenberg D A, Madoff R D, Garcia-Aguilar J. Is local excision adequate therapy for rectal cancer?.  Dis Colon Rectum. 2000;  43 1064-1074
• 29 Paty P B, Nash G M, Baron P. et al . Long-term results of local excision for rectal cancer.  Ann Surg. 2002;  236 522-559
• 30 Taylor R H, Hay J H, Larsson S N. Transanal local excision of selected low rectal cancer.  Am J Surg. 1998;  175 360-363
• 31 Wirsing K, Lorenzo-Rivero S, Luchtefeld M, Kim D, Monroe T, Attal H, Hoedema R. Local excision of stratified T1 rectal cancer.  Am J Surg. 2006;  191 410-412
• 32 Bailey H R, Huval W V, Max E, Smith K W, Butts D R, Zamora L F. Local excision of carcinoma of the rectum for cure.  Surgery. 1992;  111 555-561
• 33 Benson R, Wong C S, Cummings B J. et al . Local excision and postoperative radiotherapy for distal rectal cancer.  Int J Radiat Oncol Biol Phys. 2001;  50 1309-1316
• 34 Bleday R, Breen E, Jessup J M, Burgess A, Sentovich S M, Steel G D. Prospective evaluation of local excision for small rectal cancers.  Dis Colon Rectum. 1997;  40 388-392
• 35 Bouvet M, Milas M, Geoffrey G. et al . Predictors of recurrence after local excision and postoperative chemoradiation therapy of adenocarcinoma of the rectum.  Ann Surg Oncol. 1999;  6 26-32
• 36 Chakravarti A, Compton C C, Shellito P C. et al . Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation.  Ann Surg. 1999;  230 49-54
• 37 Coco C, Magistrelli P, Granone P, Roncolini G, Picciocchi A. Conservative surgery for early cancer of the rectum.  Dis Colon Rectum. 1992;  35 131-136
• 38 Frazee R C, Patel R, Belew M, Roberts J W, Hendricks J C. Transanal excision of rectal carcinoma.  Am Surg. 1995;  61 714-717
• 39 Le Voyer T E, Hoffman J P, Cooper H, Ross E, Sigurdson E, Eisenberg B. Local excision and chemoradiation for low rectal T1 and T2 cancers is an effective treatment.  Am Surg. 1999;  65 625-630
• 40 Minsky B D, Enker W E, Cohen A M, Lauwers G. Local excision and postoperative radiation therapy for rectal cancer.  Am J Clin Oncol. 1994;  17 411-416
• 41 Ota D M, Skibber J, Rich T A. Anderson cancer centre experience with local excision and multimodality therapy for rectal cancer.  Surg Oncol Clin North Am. 1992;  1 147-152
• 42 Russell A H, Harris J, Rosenberg P J. et al . Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02.  Int J Radiat Oncol Biol Phys. 2000;  46 313-322
• 43 Steel G D, Herndon J E, Bleday R. et al . Sphincter-sparing treatment for distal rectal adenocarcinoma.  Ann Surg Oncol. 1999;  6 433-441
• 44 Saclarides T J. Transanal endoscopic microsurgery: a single surgeon's experience.  Arch Surg. 1998;  133 595-598
• 45 Varma M G, Rogers S J, Schrock T R, Welton M L. Local excision of rectal cancer.  Arch Surg. 1999;  134 863-868
• 46 Wagman R, Minsky B D, Cohen A M, Saltz L, Paty P B, Guillem J G. Conservative management of rectal cancer with local excision and postoperative adjuvant therapy.  Int J Radiat Oncol Biol Phys. 1999;  44 841-846
• 47 Willett C G. Local excision followed by postoperative radiation therapy.  Semin Radiat Oncol. 1998;  8 24-29
• 48 Bedrosian I, Rodriguez-Bigas M A, Feig B. et al . Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma.  J Gastrointest Surg. 2004;  8 56-62 ,  discussion 62-63
• 49 Bonnen M, Crane C, Vauthey J N. et al . Long-term results using local excision after preoperative hemoradiation among selected T3 rectal cancer patients.  Int J Radiat Oncol Biol Phys. 2004;  60 1098-1105
• 50 Habr-Gama A, Perez R O, Nadalin W. et al . Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival.  J Gastrointest Surg. 2005;  9 90-99 ,  discussion 99-101
• 51 Hershman M J, Myint A S, Makin C A. Multi-modality approach in curative local treatment of early rectal carcinomas.  Colorectal Dis. 2003;  5 445-450
• 52 Kim C J, Yeatman T J, Coppola D. et al . Local excision of T2 and T3 rectal cancers after downstaging chemoradiation.  Ann Surg. 2001;  234 352-358 ,  discussion 358-359
• 53 Lezoche E, Guerrieri M, Paganini A M, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery.  Br J Surg. 2005;  92 1546-1552
• 54 Ruo L, Guillem J G, Minsky B D, Quan S H, Paty P B, Cohen A M. Preoperative radiation with or without chemotherapy and full-thickness transanal excision for selected T2 and T3 distal rectal cancers.  Int J Colorectal Dis. 2002;  17 54-58
• 55 Schell S R, Zlotecki R A, Mendenhall W M, Marsh R W, Vauthey J N, Copeland 3rd  E M. Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy.  J Am Coll Surg. 2002;  194 584-590 ,  discussion 590-591
• 56 Stipa F, Lucandri G, Ferri M, Casula G, Ziparo V. Local excision of rectal cancer with transanal endoscopic microsurgery (TEM).  Anticancer Res. 2004;  24 1167-1172
• 57 Borschitz T, Junginger T. Local excision of T2-3 rectal carcinomas after neoadjuvant chemoradiation: premesis, experiences and results. [in preparation]
• 58 Hermanek P, Gall F P. Early (microinvasive) colorectal carcinoma.  Int J Colorect Dis. 1986;  1 79-84
• 59 Hermanek P. A pathologist's point of view on endoscopically removed polyps of the colon and rectum.  Acta Hepatogastroenterol (Stuttg). 1978;  25 169-170
• 60 Coverlizza S, Risio M, Ferrari A, Fenoglio-Preiser C M, Rossini F P. Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential.  Cancer. 1989;  64 1937-1947
• 61 Jass J R, Atkin W S, Cuzick J, Bussey H J, Morson B C, Northover J M, Todd I P. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases.  Histopathology. 1986;  10 437-459
• 62 Jass J R. Lymphocytic infiltration and survival in rectal cancer.  J Clin Pathol. 1986;  39 585-589
• 63 Deinlein P, Reulbach U, Stolte M, Vieth M. Risk factors for lymphatic metastasis from pT1 colorectal adenocarcinoma.  Pathologe. 2003;  24 387-393
• 64 Hermanek P, Guggenmoos-Holzmann I, Gall F P. Prognostic factors in rectal carcinoma. A contribution to the further development of tumor classification.  Dis Colon Rectum. 1989;  32 593-599
• 65 Huddy S P, Husband E M, Cook M G, Gibbs N M, Marks C G, Heald R J. Lymph node metastases in early rectal cancer.  Br J Surg. 1993;  80 1457-1458
• 66 Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H. A system for a transanal endoscopic rectum operation.  Chirurg. 1984;  55 677-680
• 67 Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Tanaka K, Ayabe H. Surgical technique and outcome of gasless video endoscopic transanal rectal tumour excision.  Br J Surg. 2002;  89 769-774
• 68 Swanstrom L L, Smiley P, Zelko J, Cagle L. Video endoscopic transanal-rectal tumor excision.  Am J Surg. 1997;  173 383-385
• 69 Berry A R, Souter R G, Campbell W B, Mortensen N J, Kettlewell M G. Endoscopic transanal resection of rectal tumours: a preliminary report of its use.  Br J Surg. 1990;  77 134-137
• 70 Sutton C D, Marshall L J, White S A, Flint N, Berry D P, Kelly M J. Ten-year experience of endoscopic transanal resection.  Ann Surg. 2002;  235 355-362
• 71 Wetherall A P, Williams N M, Kelly M J. Endoscopic transanal resection in the management of patients with sessile rectal adenomas, anastomotic stricture and rectal cancer.  Br J Surg. 1993;  80 788-793
• 72 Kanehira E, Yamashita Y, Omura K, Kinoshita T, Kawakami K, Watanabe G. Early clinical results of endorectal surgery using a newly designed rectal tube with a side window.  Surg Endosc. 2002;  16 14-17
• 73 Maeda K, Maruta M, Sato H, Hanai T, Masumori K, Matumoto M, Koide Y, Matuoka H, Katuno H. Outcomes of novel transanal operation for selected tumors in the rectum.  J Am Coll Surg. 2004;  199 353-360
• 74 Zerz A, Muller-Stich B P, Beck J, Linke G R, Tarantino I, Lange J. Endoscopic posterior mesorectal resection after transanal local excision of T1 carcinomas of the lower third of the rectum.  Dis Colon Rectum. 2006;  49 919-924
• 75 Mason A Y. Trans-sphincter surgery of the rectum.  Prog Surg. 1974;  13 66-97
• 76 Wilson S E, Gordon H E. Excision of rectal lesions by the Kraske approach.  Am J Surg. 1969;  118 213-217
• 77 Graham R A, Garnsey L, Jessup L M. Local excision of rectal cancer.  Am J Surg. 1990;  160 306-312
• 78 Cook T A, Mortensen N J. Local methods of treatment of rectal cancer.  Colorectal Disease. 2000;  2 252-263
• 79 Jung M, Meier H J, Mennicken C, Barth H O, Manegold B C. Endoscopic and surgical therapy of malignant colorectal polyps.  Z Gastroenterol. 1988;  26 179-184
• 80 Nakagoe T, Sawai T, Tsuji T, Hidaka S, Tanaka K, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T. Additional radical surgery after colonoscopic snare polypectomy for T1 colorectal cancer: use of the minilaparotomy approach.  Int Surg. 2004;  89 10-14
• 81 Gavagan J A, Whiteford M H, Swanstrom L L. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications.  Am J Surg. 2004;  187 630-634
• 82 Baron P L, Enker W E, Zakowski M E, Urmacher C. Immediate vs. salvage resection after local treatment for early rectal cancer.  Dis Colon Rectum. 1995;  38 177-181
• 83 Morson B C. Evolution of cancer of the colon and rectum.  Cancer. 1974;  34 845-849
• 84 Nagtegaal I D, Marijnen C A, Kranenbarg E K, van de Velde C J, van Krieken J H. Pathology Review Committee, Cooperative Clinical Investigators . Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit.  Am J Surg Pathol. 2002;  26 350-357
• 85 Wibe A, Syse A, Andersen E, Tretli S, Myrvold H E, Soreide O. Norwegian Rectal Cancer Group . Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection.  Dis Colon Rectum. 2004;  47 48-58
• 86 Stipa F, Burza A, Lucandri G, Ferri M, Pigazzi A, Ziparo V, Casula G, Stipa S. Outcomes for early rectal cancer managed with transanal endoscopic microsurgery: a 5-year follow-up study.  Surg Endosc. 2006;  20 541-545
• 87 Hermanek P, Junginger T. The circumferential resection margin in rectal carcinoma surgery.  Tech Coloproctol. 2005;  9 193-199 ,  discussion 199-200
• 88 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
• 89 Floyd N D, Saclarides T J. Transanal endoscopic microsurgical resection of pT1 rectal tumors.  Dis Colon Rectum. 2006;  49 164-168
• 90 Wirsing K, Lorenzo-Rivero S, Luchtefeld M. et al . Local excision of stratified T1 rectal cancer.  Am J Surg. 2006;  191 410-412
• 91 Parr C, Jiang W G. Quantitative analysis of lymphangiogenic markers in human colorectal cancer.  Int J Oncol. 2003;  23 533-539
• 92 Borschitz T, Heintz A, Junginger T. Transanal endoscopic microsurgical excision of pT2 rectal cancer: Results and possible indications. Dis Colon Rectum 2006 [in press]
• 93 Borschitz T, Junginger T. The value of immediate versus salvage reoperation after local excision of early “high risk” and T2 rectal carcinomas. [under review]
• 94 Nakagoe T, Ishikawa H, Sawai T, Tsuji T. Long-term outcomes of radical surgery after gasless video endoscopic transanal excision of T1/T2 rectal cancers.  Eur J Surg Oncol. 2004;  30 638-642
• 95 Friel C M, Cromwell J W, Marra C, Madoff R D, Rothenberger D A, Garcia-Aguilar J. Salvage radical surgery after failed local excision for early rectal cancer.  Dis Colon Rectum. 2002;  45 875-879
• 96 Weiser M R, Landmann R G, Wong W D, Shia J, Guillem J G, Temple L K, Minsky B D, Cohen A M, Paty P B. Surgical salvage of recurrent rectal cancer after transanal excision.  Dis Colon Rectum. 2005;  48 1169-1175
• 97 Borschitz T, Junginger T, Hermanek P. Lymph node status after neoadjuvant chemoradiotherapy of rectal cancer in dependence of the yT finding. [in preparation]
• 98 Hartley A, Ho K F, McConkey C, Geh J I. Pathological complete response following pre-operative chemoradiotherapy in rectal cancer: analysis of phase II/III trials.  Br J Radiol. 2005;  78 934-938