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Operative Behandlung von Rektumkarzinomen im Vergleich

Onkologische Langzeitergebnisse einer multizentrischen Beobachtungsstudie nach laparoskopisch-assistierter, konvertierter und primär offener Operation

Long-term oncological results after laparoscopic, converted and primary open procedures for rectal carcinoma

Results of a multicenter observational study

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Zusammenfassung

Hintergrund

Die laparoskopische Rektumkarzinomresektionen hat eine den offenen Verfahren vergleichbare Morbidität und onkologische Sicherheit bei jedoch deutlich höherer Morbidität nach Konversion. Zu den onkologischen Langzeitergebnisse nach Konversion liegen keine Daten vor.

Methode

Vom 01.01.2000–31.12.2002 in einer Beobachtungsstudie erfasste Patienten mit kurativ reseziertem Rektumkarzinom wurden hinsichtlich der postoperativen Morbidität, Letalität, des tumor- und lokalrezidivfreien Überlebens nach laparoskopischer vs. konvertierter vs. offener Resektion verglichen.

Ergebnisse

Von 7189 Patienten wurden 237 (3,3%) laparoskopisch (ITT) reseziert. Diese Patienten hatten signifikant häufiger T1/2-Tumore (p<0,001) in früheren UICC-Stadien (p<0,001) als die offen resezierten. Die Konversionsrate betrug 14,8% (n=35). Die Konversionsgruppe hatte signifikant mehr intraoperative (p<0,001) und allgemeine postoperative Komplikationen (p=0,003) sowie die höchste Gesamtmorbidität (p=0,031) im Vergleich zur laparoskopischen und offenen Resektion. Nach einem medianen Follow-up von 30.1 Monaten zeigten die konvertierten Patienten die höchste 5-J-Lokalrezidivrate (16.0%). Nach laparoskopischer sowie offener Resektion betrug diese 3.3% resp. 12.4% (p=0.082). Die tumorfreie 5-J-Üerlebensrate war vergleichbar (p=0.585).

Schlussfolgerungen

Die laparoskopische Rektumkarzinomresektion bietet gegenüber der offenen Resektion vergleichbare onkologische Ergebnisse, jedoch ist nach Konversion das frühpostoperative und das onkologische Langzeit-Outcome schlechter. Bei Konversionsraten um 15% ist eine strenge Patientenselektion und Durchführung der laparoskopischen Resektion an Zentren zu fordern.

Abstract

Background

The laparoscopic resection of rectal cancer shows morbidity and oncological safety comparable to the open approach, but morbidity increases after conversion to open resection. No oncological long-term results are available for the latter patients.

Methods

From 01/01/2000–31/12/2002, patients with curatively resected rectal cancer enrolled in a observational study were evaluated for morbidity, mortality, tumor- and local recurrence rate, paying attention to patients with conversion from laparoscopic to open resection.

Results

237 (3.3%) of 7,189 patients underwent laparoscopic resection (ITT). These patients showed significantly more T1/2 tumors (P<0.001) in earlier UICC stages (P<0.001) than open resected patients. 35 (14.8%) of 237 laparoscopic procedures were converted. Compared with patients receiving complete laparoscopic or open resection, these patients showed significantly higher frequencies of intraoperative (P<0.001) and general postoperative complications (P=0.003) as well as the highest overall morbidity (P=0.031). After a median follow-up of 30.1 months, the highest 5-year local recurrence rate was found in the converted group (16.0%). The laparoscopically resected patients showed a local recurrence rate of 3.3%, patients with open resection of 12.4% (P=0.082). The disease-free survival rate did not differ between the groups (P=0.585).

Conclusion

Laparoscopic resection of rectal cancer provides oncological results similar to open resection. After conversion, the short and oncological long-term outcomes were worse. Considering a conversion rate of 15%, only a strict indication for the laparoscopic approach can be allowed, and laparoscopic resection should be performed at centers.

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Ptok, H., Steinert, R., Meyer, F. et al. Operative Behandlung von Rektumkarzinomen im Vergleich. Chirurg 77, 709–717 (2006). https://doi.org/10.1007/s00104-006-1199-y

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