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.

Schlüsselwörter

Rektumkarziom - laparoskopische Resektion - früh-postoperative Ergebnisse - Langzeitergebnisse

Key words

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

Literatur

• 1 Braga M, Vignali A, Gianotti L. et al . Laparoscopic versus open colorectal surgery: a randomized trail on short-term outcome.  Ann Surg. 2002;  236 759-767
• 2 Lacy A M, Garcia-Valdecasas J C, Delgado S. et al . Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: A randomized trail.  Lancet. 2002;  359 2224-2229
• 3 Morino M, Allaix M E, Giraudo G. et al . Laparoscopic versus open surgery for extraperitoneal rectal cancer: A prospective comparative study.  Surg Endosc. 2005;  19 1460-1467
• 4 Schwander O, Schiedeck T HK, Killaitis C. et al . A case-control-study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer.  Int J Colorectal Dis. 1999;  14 158-163
• 5 Weeks J C, Nelson H, Gelber S. et al . Short-term Quality-of-life outcomes following laparocopic-assisted colectomy vs open colectomy for colon cancer: A randomized trail.  JAMA. 2002;  287 321-328
• 6 Schwenk W, Neudecker J, Raue W. et al . Fast-track rehabilitation after rectal cancer resection.  Int J Colorectal Dis. 2005;  9 1-7
• 7 The Colon Cancer Laparoscopic or Open Resection Study Group .Laparoscopic surgery versus open surgery for colon cancer: Short-term outcomes of a randomized trail. Lancet Oncol 2005; online publication: DOI 10.1016/S1470-2045(05)70-221-7
• 8 The Clinical Outcomes of Surgical Therapy Study Group . A comparision of laparoscopically assisted and open colectomy for colon cancer.  N Engl J Med. 2004;  350 2050-2059
• 9 Guillou P J, Quirke P, Thorpe H. et al . Short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASSIC trail): multicentre, randomized controlled trail.  Lancet. 2005;  365 1718-1726
• 10 Bretagnol F, Lelong B, Laurent C, Moutardier V, Rullier A, Monges G, Delpero J R, Rullier E. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma.  Surg Endosc. 2005;  19 892-896
• 11 Bärlehner E, Benhidjeb T, Anders S. et al . Laparoscopic resection for rectal cancer: Outcomes in 194 patients and review of the literature.  Surg Endosc. 2005;  19 757-766
• 12 Scheidbach H, Schneider C, Konradt J. et al . Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.  Surg Endosc. 2002;  16 7-13
• 13 Zhou Z G, Hu M, Li Y, Lei W Z, Yu Y Y, Cheng Z, Li L, Shu Y, Wang T C. Laparoskopic vs open total mesorectal excision with anal sphincter preservation for low rectal cancer.  Surg Endosc. 2004;  18 1211-1215
• 14 Schwenk W, Haase O, Neudecker J, Müller J M. Short term benefits for laparoscopic colorectal resection. The Cochrane Database of systematic Reviews 2005; Issue 2. Art No.: CD003145
• 15 Aziz O, Constantinides V, Tekkis P P, Athanasius T, Purkayastha S, Paraskeva P, Darzi A W, Heriot A G. Laparoscopic versus open surgery for rectal cancer: A meta-analysis.  Ann Surg Oncol. 2006;  13 413-424
• 16 Raue W, Haase O, Junghans T. et al . Fast-track multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy. A controlled prospective evaluation.  Surg Endosc. 2004;  18 1463-1468
• 17 Regadas F S, Rodrigues L V, Nicodemo A M, Siebra J A, Furtado D C, Regadas S M. Complications in laparoscopic colorectal resections: main types and prevention.  Surg Laparosc Endosc. 1998;  8 189-192
• 18 Marohn M R, Hanly E J, McKenna K J, Varin C R. Laparoskopic total abdominal colectomy in the acute setting.  J Gastrointest Surg. 2005;  9 881-887
• 19 Israelsson L A, Smedberg S, Montgomery A, Nordin P. Incisional hernia repair in Sweden 2002.  Hernia. 2006;  23 Epub ahead of print-1
• 20 Gonze J, Klinge U, Schumpelick V. Incisional hernia.  Chirurg. 2005;  76 897-910
• 21 Heald R J, Husband E M, Ryall R DH. The mesorectum in rectal cancer surgery - the clue to pelvic recurrence?.  Br J Surg. 1982;  69 613-616
• 22 Heald R J, Moran B J, Ryall R D. et al . Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978-1997.  Arch Surg. 1998;  133 894-899
• 23 Köckerling F, Reymond M A, Schneider C. et al . Prospective multicenter study of the quality of oncologic resection in patients undergoing laparoscopic colorectal surgery for cancer.  Dis Colon Rectum. 1998;  41 963-970
• 24 Pikarsky A J, Rosenthal R, Weiss E G. et al . Laparoscopic total mesorectal excision.  Surg Endosc. 2002;  16 558-562
• 25 Rullier E, Sa Cunha A, Couderc P. et al . Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer.  Br J Surg. 2003;  90 440-444
• 26 Tomita H, Marcello P W, Milsom J W. Laparoscopic surgery of the colon and Rectum.  World J Surg. 1999;  23 397-405
• 27 Wu W X, Sun Y M, Hua Y B, Shen L Z. Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study.  World J Gastroenterol. 2004;  10 1167-1170
• 28 Breukink S O, Grond A JK, Pierie J PEN. et al . Laparoscopic vs. open total mesorectal excision for rectal cancer: An evaluation of the mesorectum's macroscopic quality.  Surg Endosc. 2005;  19 307-310
• 29 Leung K L, Kwok S P, Lam S C, Lee J F, Yiu R Y, Ng S S, Lai P B, Lau W Y. Laparoscopic resection of rectosigmoid carcinoma: Prospective randomised trail.  Lancet. 2004;  363 1187-1192
• 30 Lezoche E, Guerrieri M, De Sanctis A, Campagnacci R, Baldarelli M, Lezoche G, Paganini A M. Long-term results of laparoscopic versus open colorectal resections for cancer in 235 patients with a minimum follow-up of 5 years.  Surg Endosc. 2006;  20 546-553
• 31 Fleshman J W, Wexner S D, Anvari M, La Tulippe J F, Birnbaum E H, Kodner I J, Read T E, Nogueras J J, Weiss E G. Laparoscopic vs. open abdominoperineal resection for cancer.  Dis Colon Rectum. 1999;  42 930-939
• 32 Weaver D W, Eachempati S R. Laparoscopically assisted transsacral resection of rectal cancer with primary anastomosis: A preliminary review.  Surg Endosc. 2000;  14 703-707
• 33 Veldkamp R, Gholghesaei M, Bonjer H J, Meijer D W, Buunen M, Jeekel J, Anderberg B, Cuesta M A, Cuschieri A, Fingerhut A, Fleshman J W, Guillou P J, Haglind E, Himpens J, Jacobi C A, Jakimowicz J J, Koeckerling F, Lacy A M, Lezoche E, Monson R J, Morino M, Neugebauer E, Wexner S D, Whelan R L. Laparoscopic resection of colon cancer. Consensus of the European Association of Endoscopic Surgery (E.A.E.S.).  Surg Endosc. 2004;  18 1163-1185
• 34 Dulucq J L, Wintringer P, Stabilini C. et al . Laparoscopic rectal resection with anal sphincter preservation for rectal cancer.  Surg Endosc. 2005;  19 1468-1474
• 35 Jacob B P, Salky B. Laparoscopic colectomy for colon adenocarcinoma: an 11-year retrospective review with 5-year survival rates.  Surg Endosc. 2005;  19 643-649
• 36 Slim K, Pezet D, Riff Y. et al . High morbidity rate after converted laparoscopic colorectal surgery.  Br J Surg. 1995;  82 1406
• 37 Bruch H P, Esnaashari H, Schwandner O. Current status of laparoscopic therapy of colorectal cancer.  Dig Dis. 2005;  23 127-134
• 38 Leroy J, Jamali F, Forbes L. et al . Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: Long-term outcomes.  Surg Endosc. 2004;  18 281-289
• 39 Poulin E C, Schlachta C M, Grégoire R. et al . Local recurrence and survival after laparoscopic mesorectal resection for rectal adenocarcinoma.  Surg Endosc. 2002;  16 989-995
• 40 Abraham N S, Young J M, Solomon M J. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer.  Br J Surg. 2004;  91 1111-1124