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Zentralbl Chir 2015; 140(06): 627-632
DOI: 10.1055/s-0033-1350816
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Qualität der Mesorektumexzision („plane of surgery“) – Welche Qualitätsziele sind angemessen?

Quality of Mesorectal Excision (“Plane of Surgery”) – Which Quality Targets are Adequate?
P. Hermanek
1   Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
,
S. Merkel
1   Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
,
H. Ptok
2   An-Institut für Qualitätssicherung in der operativen Medizin, Otto-von-Guericke-Universität Magdeburg, Deutschland
,
W. Hohenberger
1   Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
› Author Affiliations
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Publication History

Publication Date:
04 December 2013 (online)

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Zusammenfassung

An Resektionspräparaten mit Rektumkarzinom ist heute die makroskopische Beurteilung der Qualität der Mesorektumexzision durch den Pathologen obligatorisch. Dabei wird der „plane of surgery“ beurteilt, wobei insbesondere die Häufigkeit der Operation im Muscularis propria Plane of Surgery (früher als inkomplette Mesorektumexzision bezeichnet) interessiert. Die Qualität der Mesorektumexzision ist von prognostischer Bedeutung, da vor allem Lokalrezidive nach Operation im Muscularis propria Plane of Surgery häufiger beobachtet werden. Daten von insgesamt 13 zwischen 2006 und 2012 publizierten Studien mit jeweils mehr als 100 Patienten und entsprechender Spezialisierung und Erfahrung der Operateure (5413 Patienten), Daten der prospektiven multizentrischen Beobachtungsstudie „Qualitätssicherung – Rektumkarzinome“ des An-Instituts für Qualitätssicherung in der operativen Medizin an der Otto-von-Guericke-Universität Magdeburg der Jahre 2005–2010 (8044 Patienten) sowie Daten der Chirurgischen Klinik am Universitätsklinikum Erlangen aus der Zeit zwischen 1998 und 2011 (991 Patienten) wurden analysiert, um eine Definition für Qualitätsziele zu erarbeiten. Dabei ergab sich eine Gesamthäufigkeit von Operationen im Muscularis propria Plane of Surgery von 721/14 448 (5,0 %). Die Häufigkeit von Operationen im Muscularis propria Plane ist auch bei entsprechender Spezialisierung und Erfahrung bei abdominoperinealen Exstirpationen größer als bei Operationen mit Sphinktererhalt (8,4 vs. 2,8 %, p < 0,001). Daher sollte als Qualitätsziel für die Häufigkeit von Operationen im Muscularis propria Plane bei Sphinktererhalt < 5 %, bei abdominoperinealer Exstirpation < 10 % festgelegt werden.

Abstract

Today, the examination of rectal cancer specimens includes the obligate macroscopic assessment of the quality of mesorectal excision by the pathologist reporting the plane of surgery. The frequency of operations in the muscularis propria plane of surgery (earlier described as incomplete mesorectal excision) is essential. The quality of mesorectal excision is important for the prognosis, especially as local recurrences are observed more frequently after operations in the muscularis propria plane of surgery. For the definition of quality targets, data of 13 studies published between 2006 and 2012, each with more than 100 patients and adequate specialisation and experience of the surgeons (5413 patients), data of the prospective multicentric observation study “Quality Assurance – Rectal Cancer” (at the Institute for Quality Assurance in Operative Medicine at the Otto-von-Guericke University at Magdeburg) from 2005 to 2010 (8044 patients) and data of the Department of Surgery, University Hospital Erlangen, from 1998 to 2011 (991 patients) were analysed. The total incidence of operations in the muscularis propria plane of surgery was 5.0 % (721/14 448). Even with adequate specialisation and experience of the surgeon, the frequency of operations in the muscularis propria plane of surgery is higher in abdominoperineal excisions than in sphincter-preserving surgery (8.4 vs. 2.8 %, p < 0.001). Thus, the quality target for the frequency of operations in the muscularis propria plane should be defined as < 5 % for sphincter-preserving procedures and as < 10 % for abdominoperineal excisions.

Schlüsselwörter

Rektumkarzinom - Qualität der Mesorektumexzision - Plane of surgery - Qualitätsziele

Key words

rectal carcinoma - quality of mesorectal excision - plane of surgery - quality targets
 

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