Kolorektales Karzinom

Colorectal carcinoma. Minimal invasive surgery under quality aspects - limits

Summary

Owing to a lack of long-term survival in prospective randomized studies controversy continues to surround the use of laparoscopic resection in cases of colorectal carcinoma. However short-term survival and recurrence rate seem to be similar to conventional procedures. Mortality and morbidity rates following laparoscopic surgery seem to be equal to conventional surgery. Oncological problems associated with laparoscopic colorectal surgery with curative intent include inadequate radicality, incorrect surgical technique, and failure to observe the technical and/or oncological limitations applicable to certain tumor sites. Carcinomas of the right and left hemicolon, colon sigmoideum and of the lower rectum without a possibility of continence preservation can be safely treated by laparoscopy. All other locations, tumors with a size greater than 8 cm and tumors involving the surrounding tissue are technically demanding and difficult to be treated laparoscopically following oncological criteria. The incidence and pathogenesis of trocar site metastases are unknown. Surgical concepts to avoid these sequelae are not established.

Zusammenfassung

Die Indikation zur Durchführung laparoskopischer Resektionen beim kolorektalen Karzinom ist aufgrund fehlender Langzeitergebnisse in prospektiv randomisierten Studien nach wie vor umstritten. Die bisher vorliegenden Kurzzeitergebnisse zeigen keine erhöhte Rezidivrate im Vergleich zu den offenen Verfahren. Die perioperative Mortalität und Morbidität nach laparoskopischen Eingriffen scheint vergleichbar mit den offenen Verfahren. Mögliche Probleme der Laparoskopie in der kurativen Therapie kolorektaler Malignome bestehen in einer inadäquaten Radikalität aufgrund unzureichender Operationstechnik sowie technisch-onkologischer Grenzen bei bestimmten Tumorlokalisationen und Tumorausdehnungen. Während unter onkologischen Kriterien Tumoren des rechten und linken Hemikolon, des Sigmas und des distalen Rektum, bei denen eine kontinenzerhaltende Resektion nicht möglich ist, sicher durchführbar sind, sind derzeit Dickdarmtumoren anderer Lokalisationen, Tumoren > 8 cm sowie organübergreifende Tumoren onkologisch bedenklich bzw. technisch problematisch. Die Inzidenz und Bedeutung der Implantationsmetastasen in der Bauchdecke ist ungeklärt. Chirurgische Strategien zur Vermeidung dieser Metastasen sind noch nicht ausreichend überprüft.

Key words

Minimal invasive surgery - colorectal carcinoma

Schlüsselwörter

Minimal-invasive Chirurgie - kolorektales Karzinom

Literatur

• 1 Adachi Y, Sato K, Shiraishi N, Kakisako K, Tanimura H, Kitano S. Tumor size of colorectal cancer: indication for laparoscopic surgery.  Surg Laparosc Endosc. 1998;  8 269-272
• 2 Agachan F, Joo J S, Sher M, Weiss E G, Nogueras J J, Wexner S D. Laparoscopic colorectal surgery.  Surg Endosc. 1997;  11 331-335
• 3 Alexander R JT, Jaques B C, Mitchell K G. Laparoscopically assisted colectomy and wound recurrence.  Lancet. 1993;  341 249-250
• 4 Bärlehner E, Heukrodt B, Anders S. Laparoscopic rectum surgery in carcinoma.  Zentralbl Chir. 1998;  123 1164-1168
• 5 Barnett R B, Clement G S, Drizin G S, Josselon A S, Prince D S. Pulmonary changes after laparoscopic cholecystectomy.  Surg Laparosc Endosc. 1992;  2 125-127
• 6 Bennett C J, Stryker S J, Ferreira M R, Adams J, Beart R W. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1 194 laparoscopic-assisted colectomies.  Arch Surg. 1997;  132 41-44
• 7 Bergamaschi R, Arnaud J P. Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease.  Surg Endosc. 1997;  11 802-804
• 8 Bokey E L, Moore J W, Chapuis P H, Newland R C. Morbidity and mortality following laparoscopic-assisted right hemicolectomy for cancer.  Dis Colon Rectum. 1996;  39 24-28
• 9 Chew D K, Borromeo J R, Kimmelstiel F M. Peritoneal mucinous carcinomatosis after laparoscopic-assisted anterior resection for early rectal cancer: report of a case.  Dis Colon Rectum. 1999;  42 424-426
• 10 Cirocco W C, Schwartzman A, Golub R W. Abdominal wall recurrence after laparoscopic colectomy for colon cancer.  Surgery. 1994;  116 842-846
• 11 Delgado S, Lacy A M, Garcia Valdecasas J C, Balague C, Salvador L, Momblan D, Visa J. Could age be an indication for laparoscopic colectomy in colorectal cancer?.  Surg Endosc. 2000;  14 22-26
• 12 Fielding G A, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R. Laparoscopic colectomy.  Surg Endosc. 1997;  11 745-749
• 13 Fleshman J W, Nelson H, Peters W R, Kim H C, Larach S, Boorse R R, Ambroze W, Leggett P, Bleday R, Stryker S, Christenson B, Wexner S, Senagore A, Rattner D, Sutton J, Fine A P. Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group.  Dis Colon Rectum. 1996;  39 53-58
• 14 Franklin M E, Rosenthal D, Norem R F. Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma.  Surg Endosc. 1996;  9 811-816
• 15 Gellman L, Salky B, Edye M. Laparoscopic-assisted colectomy.  Surg Endosc. 1996;  10 1041-1044
• 16 Goh Y C, Eu K W, Seow-Choen F. Early postoperative results of a prospective series of laparoscopic versus open anterior resections for rectosigmoid cancers.  Dis Colon Rectum. 1997;  40 776-780
• 17 Guillou P J. Laparoscopic surgery for diseases of the colon and rectum - quo vadis?.  Surg Endosc. 1994;  8 669-671
• 18 Heald R J, Karanjia N D. Results of radical surgery for rectal cancer.  World J Surg. 1992;  16 848-857
• 19 Herfarth Ch, Runkel N. Chirurgische Standards beim primären Coloncarcinom.  Chirurg. 1994;  65 514-523
• 20 Hermanek P, Wiebelt H, Staimmer D, Riedl St. and the German Study Group Colorectal Carcinoma (SGCRC) . Prognostic factors of rectal carcinoma. Experience of the German Multicenter Study SGCRC.  Tumori. 1995;  81 (S1) 60-64
• 21 Hewitt P J, Thomas W M, King G, Eaton M. Intraperitoneal cell movement during abdominal carbon oxide insufflation and laparoscopy.  Dis Colon Rectum. 1996;  39 62-66
• 22 Hoffman G C, Baker J W, Fitchett C W, Vansant J H. Laparoscopic-assisted colectomy. Initial experience.  Ann Surg. 1994;  219 732-740
• 23 Hoffman G C, Baker J W, Doxey J B, Hubbard G W. Minimal invasive surgery for colorectal cancer.  Ann Surg. 1996;  223 790-798
• 24 Hughes E SR, McDermott F T, Polglase A L, Johnson W R. Tumor recurrence in the abdominal wall scar tissue after large bowel cancer surgery.  Dis Colon Rectum. 1983;  26 571-572
• 25 Huscher C, Silecchia G, Croce E, Farello G A, Lezoche E, Morino M, Azzola M, Feliciotti F, Rosato P, Tarantini M, Basso N. Laparoscopic colorectal resection. A multicenter Italian study.  Surg Endosc. 1996;  10 875-879
• 26 Jakobs M, Verdeja J C, Goldstein H S. Minimal invasive colon resection.  Surg Laparosc Endosc. 1991;  1 144-150
• 27 Khalili T M, Fleshner P R, Hiatt J R, Sokol T P, Manookian C, Tsushima G, Phillips E H. Colorectal cancer: comparison of laparoscopic with open approaches.  Dis Colon Rectum. 1998;  41 832-838
• 28 Kingston R D, Walsh S, Jeacock J. Colorectal surgeons in district general hospitals produce similar survival outcomes to their teaching hospital collegues: review of 5-year survivals in Manchester.  J R Coll Surg Edinb. 1992;  37 235-237
• 29 Köckerling F, Gall F P. Chirurgische Standards beim Rectumcarcinom.  Chirurg. 1994;  65 593-603
• 30 Köckerling F, Reymond M A, Schneider C, Hohenberger W. Fehler und Gefahren in der onkologischen laparoskopischen Chirurgie.  Chirurg. 1997;  68 215-224
• 31 Köckerling F, Rose J, Schneider C, Scheidbach H, Scheurlein H, Reymond M A, Reck T, Konradt J, Bruch H P, Zornig C, Bärlehner E, Kuthe A, Szinicz G, Richter H A, Hohenberger W. Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG).  Surg Endosc. 1999;  13 639-644
• 32 Köckerling F, Reymond M A, Schneider C, Wittekind C, Scheidbach H, Konradt J, Kohler L, Bärlehner E, Kuthe A, Bruch H P, Hohenberger W. Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. The Laparoscopic Colorectal Surgery Study Group.  Dis Colon Rectum. 1998;  41 963-970
• 33 Kuthe A, Faust H, Quast G, Reichel K. Laparoskopische resektive Eingriffe bei kolorektalem Karzinom.  Minimal Invasive Chir. 1996;  5 2
• 34 Kwok S P, Lau W Y, Carey P D, Kelly S B, Leung K L, Li A K. Prospective evaluation of laparoscopic-assisted large bowel excision for cancer.  Ann Surg. 1996;  223 170-176
• 35 Lacy A M, Delgado S, Garcia-Valdecasas J C, Castells A, Pique J M, Grande L, Fuster J, Targarona E M, Pera M, Visa J. Port site metastases and recurrence after laparoscopic colectomy. A randomized trial.  Surg Endosc. 1998;  12 1039-1042
• 36 Leung K L, Kwok S P, Lau W Y, Meng W C, Lam T Y, Kwong K H, Chung C C, Li A K. Laparoscopic-assisted resection of rectosigmoid carcinoma. Immediate and medium-term results.  Arch Surg. 1997;  132 761-764
• 37 Leung K L, Meng W C, Lee J F, Thung K H, Lai P B, Lau W Y. Laparoscopic-assisted resection of right-sided colonic carcinoma: a case-control study.  J Surg Oncol. 1999;  71 97-100
• 38 Leung K L, Kwok S PY, Lau W Y, Meng W CS, Chung C C, Lai P BS, Kwong K H. Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma.  Surg Endosc. 2000;  14 67-70
• 39 Lord S A, Larach S W, Ferrara A, Williamson P R, Lago C P, Lube M W. Laparoscopic resection for colorectal carcinoma. A three-year experience.  Dis Colon Rectum. 1996;  39 148-154
• 40 Lumley J W, Fielding G A, Rhodes M, Nathanson L K, Siu S, Stitz R W. Laparoscopic-assisted colorectal surgery. Lessons learned from 240 consecutive patients.  Dis Colon Rectum. 1996;  39 155-159
• 41 McMahon A J, Baxter J N, Kenny G, O'Dwyer P J. Ventilatory and blood gas changes during laparoscopic and open cholecystectomy.  Br J Surg. 1993;  80 1252-1254
• 42 Miller B A, Ries L AG, Mankey B F, Kosary C L. SEER Cancer statistics review: 1973-1990. NIH Publ. N0. 93, 2789. National Cancer Institute, Bethesda 1993
• 43 Milsom J W, Casillas S. Current status in laparoscopic colorectal surgery.  Rev Gastroenterol Mex. 1996;  61 113-118
• 44 Milsom J W, Bohm B, Hammerhofer K A, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report.  J Am Coll Surg. 1998;  187 46-54
• 45 Monson J RT, Darzi A, Declan Carey P, Guillou P J. Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients.  Lancet. 1992;  340 831-833
• 46 Musser D J, Boorse R C, Madera F, Reed F F. Laparoscopic colectomy: at what cost?.  Surg Laparosc Endosc. 1994;  4 1-5
• 47 Nduka C C, Monson J RT, Menzies-Gow N, Darzi A. Abdominal wall metastases following laparoscopy.  Br J Surg. 1994;  81 648-652
• 48 O'Rourke N A, Heald R J. Laparoscopic surgery for colorectal cancer.  Br J Surg. 1993;  80 1229-1230
• 49 Ortega A E, Beart R W, Steele G D, Winchester D P, Greene F I. Laparoscopic bowel surgery registry. Preliminary results.  Dis Colon Rectum. 1995;  38 681-685
• 50 Peters J H, Ellison C, Innes J T, Liss B A, Nichols K E, Lomano J M, Roby S R, Front M E, Carey L C. Safety and efficacy of laparoscopic cholecystectomy.  Ann Surg. 1991;  213 3-12
• 51 Philipson B M, Bokey E L, Moore J W, Chapuis P H, Bagge E. Cost of open versus laparoscopically assisted right hemicolectomy for cancer.  World J Surg. 1997;  21 214-217
• 52 Poulin E C, Mamazza J, Schlachta C M, Gregoire R, Roy N. Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma.  Ann Surg. 1999;  229 487-492
• 53 Ramos J M, Gupta S, Anthone G J, Ortega A E, Simons A J, Beart R W. Laparoscopy and colon cancer - Is the port site at risk?.  Arch Surg. 1994;  129 897-899
• 54 Reissman P, Cohen S, Weiss E G, Wexner S D. Laparoscopic colorectal surgery: ascending the learning curve.  World J Surg. 1996;  20 277-282
• 55 Reymond M A, Wittekind C, Jung A, Hohenberger W, Kirchner T, Köckerling F. The incidence of port-site metastases might be reduced.  Surg Endosc. 1997;  11 902-906
• 56 Schaeff B, Paolucci V, Thomopoulos J. Port site recurrences after laparoscopic surgery. A review.  Dig Surg. 1998;  15 124-134
• 57 Schwandner O, Schiedeck T HK, Bruch H P. The role of conversion in laparoscopic colorectal surgery. Do predictive factors exist?.  Surg Endosc. 1999;  13 151-156
• 58 Schwenk W, Bohm B, Muller J M. Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial.  Surg Endosc. 1998;  12 1131-1136
• 59 Senagore A J, Luchtefeld M A, Mackeigan J M. What is the learning curve for laparoscopic colectomy?.  Am Surg. 1995;  61 681-685
• 60 Slim K, Pezet D, Stencl J, Lagha K, Le Roux S, Lechner C, Chippioni J. Prospective analysis of 40 initial laparoscopic colorectal resections: a plea for a randomized trial.  J Laparoendosc Surg. 1994;  4 241-245
• 61 Stoker M E, Vose J, O'Mara P, Naini B S. Laparoscopic cholecystectomy: a clinical and financial analysis of 280 operations.  Arch Surg. 1992;  127 589-594
• 62 Tate J J, Kwok S, Dawson J W, Lau W Y, Li A K. Prospective comparison of laparoscopic and conventional anterior resection.  Br J Surg. 1993;  80 1396-1398
• 63 Tomita H, Marcello P W, Milsom J W. Laparoscopic surgery of the colon and rectum.  World J Surg. 1999;  23 397-405
• 64 Treat M R, Bessler M, Whelan R L. Mechanisms to reduce incidence of tumor implantation during minimal access procedures for colon cancer.  Sem Laparosc Surg. 1995;  2 176-178
• 65 Trebuchet G, Le Calve J, Launois B. Laparoscopic resection of the colon for adenocarcinoma. Report of a series of 218 cases.  Zentralbl Chir. 1998;  123 343-350
• 66 Tucker J G, Ambroze W L, Orangio G R, Duncan T D, Mason E M, Lucas G W. Laparoscopically assisted bowel surgery. Analysis of 114 cases.  Surg Endosc. 1995;  9 297-300
• 67 Vukasin P, Ortega A E, Greene F L, Steele G D, Simons A J, Anthone G J, Weston L A, Beart R W. Wound recurrence following laparoscopic colon cancer resection. Results of the American Society of Colon and Rectal Surgeons Laparoscopic Registry.  Dis Colon Rectum. 1996;  39 S 20-S 23
• 68 Wexner S D, Buess G, Jager R M, Mouson J RT, Sachier J. Laparoscopic resections for colorectal cancer.  Contemp Surg. 1995;  46 93-111
• 69 Wexner S D, Cohen S M. Port site metastases after laparoscopic colorectal surgery for cure of malignancy.  Br J Surg. 1995;  82 295-298