Laparoskopische Therapie des kolorektalen Karzinoms - Wunschdenken oder Realismus?

 

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Zusammenfassung

Laparoskopische Resektionen am Kolon und Rektum sind bei benignen Erkrankungen etabliert. Ihr Vorteil gegenüber der offen-konventionellen Operationstechnik liegt in reduzierter postoperativer Schmerzsymptomatik, geringerer Beeinträchtigung der pulmonalen sowie gastrointestinalen Funktionen und einer kürzeren Rekonvaleszenz. Kurative Eingriffe in minimalinvasiver Technik werden beim kolorektalen Karzinom bezüglich Radikalität und Tumorzellverschleppung noch immer kontrovers diskutiert. Die onkologischen Standards der konventionellen Chirurgie können bei laparoskopischen Resektionen am Kolon und Rektum ohne Einschränkung eingehalten werden. In den jüngeren Vergleichstudien werden keine erhöhten Rezidiv- oder niedrigere Überlebensraten nach minimalinvasivem Vorgehen publiziert. Den Nachweis eines vergleichbaren Langzeitüberlebens müssen die prospektiv randomisierten Multizenterstudien in den nächsten Jahren erbringen.

Abstract

The laparoscopic resection of the colon and rectum is established for surgery of benign diseases. The main advantages compared to the open-conventional operation technique are reduced postoperative pain, reduced negative influences on pulmonary and gastrointestinal functions as well as a shorter reconvalescence. Minimally invasive curative resections of colorectal carcinomas are still controversially discussed concerning sufficient radicality and the spread of tumor cells. The given oncological standards of the conventional approach can be kept without restriction when resections of the colon and rectum are performed laparoscopically. Newer comparative studies do not describe raised recurrence or lower survival rates following the minimal-invasive procedure. In the coming years prospective randomized multicenter studies must give proof whether or not the long-term survival is comparable with the conventional approach.

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Prof. Dr. med. H.-P. Bruch

Klinik für Chirurgie

Universitätsklinikum Schleswig-Holstein

Campus Lübeck

Ratzeburger Allee 160

23538 Lübeck

Phone: (+49) (0) 45 15 00 20 01

Fax: (+49) (0) 45 15 00 20 69

Email: Bruch@medinf.mu-luebeck.de