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Evidenzlage der laparoskopischen Chirurgie beim Rektumkarzinom

Scientific evidence for laparoscopic rectal cancer surgery

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Zusammenfassung

Hintergrund

Neue Operationstechniken in der kolorektalen Chirurgie verfolgen das Ziel einer möglichst geringen Patientenbelastung bei mindestens äquivalenter und möglichst verbesserter Behandlungs- und Ergebnisqualität. Hochwertige klinische Studien sind in der Evaluation sinnvoll erscheinender Innovationen notwendig und sollen die Machbarkeit, aber auch die Vorteile (oder Nachteile) neuer Operationstechniken bewerten.

Fragestellung

Die laparoskopische Kolonkarzinomchirurgie ist durch eine Reihe exzellenter prospektiv randomisierter Studien hinsichtlich Sicherheit und onkologischer Qualität untersucht (COST-Study, COLOR-I, CLASICC). Die Patienten profitieren von den Vorteilen des geringeren Zugangstraumas, ohne Einschränkungen in der onkologischen Radikalität hinnehmen zu müssen. Können diese positiven Ergebnisse auf die Rektumkarzinomchirurgie übertragen werden?

Ergebnisse

In der Rektumkarzinomchirurgie konnten aktuell die Frühergebnisse der COLOR-II-Studie veröffentlicht werden, in der eindeutig nachgewiesen werden konnte, dass die laparoskopische Technik dem konventionellen offenen Vorgehen nicht unterlegen ist. Hinsichtlich Blutverlust, postoperativem Schmerzniveau, Krankenhausverweildauer und lateralem Sicherheitsabstand im distalen Rektumdrittel fanden sich signifikante Vorteile für die laparoskopische Operationstechnik. Die onkologischen Langzeitergebnisse (Lokalrezidivrate als primärer Endpunkt der Studie) zeigen ebenfalls einen günstigen Trend für die minimal-invasive Rektumchirurgie und werden demnächst publiziert.

Zusammenfassung

Die Sicherheit und die onkologische Qualität laparoskopischer Resektionsverfahren beim Rektumkarzinom sind durch klinische Studien gut belegt. In erfahrenen Zentren wird die laparoskopische Operationstechnik immer mehr zum Goldstandard in der Rektumkarzinomchirurgie.

Abstract

Background

Innovative surgical techniques in colorectal surgery aim to provide diminished surgical injury and at least equivalent or even improved quality of treatment and oncological results. High level clinical studies are mandatory to examine the feasibility and advantages (or disadvantages) of new operative techniques.

Objectives

Laparoscopic colonic resection for cancer has been investigated with respect to safety and oncological quality in various prospective randomized studies (COST study, COLOR-I and CLASICC). The minimally invasive procedure is feasible and safe which was demonstrated in many studies but can these results be extrapolated to laparoscopic rectal cancer surgery?

Results

The short term outcomes of the COLOR-II trial were published recently and laparoscopic resection for rectal cancer was not found to be inferior compared to open resection. Recovery after laparoscopic surgery was better than after open surgery. Laparoscopic surgery was found to have significant advantages with respect to blood loss, operating time, use of pain medication, early restoration of bowel function and reduction of hospital stay as well as the lateral safety margins in the distal third of the rectum. The long-term results focussing on local recurrence showed a positive trend in favor of laparoscopic rectal surgery and will be published shortly.

Conclusion

Laparoscopic total mesorectal excision (TME) appears to have clinically measurable short-term advantages in patients with primary rectal cancer based on the evidence of randomized studies. Laparoscopic rectal cancer resection may become the gold standard in the future.

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Literatur

  1. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  2. Abraham NS, Young JM, Solomon MJ (2004) Metaanalysis of short-term-outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124

    Article  CAS  PubMed  Google Scholar 

  3. Agha A, Fürst A, Hierl J et al (2008) Laparoscopic surgery for rectal cancer – oncological results and clinical outcome of 225 patients. Surg Endosc 22:2229–2237

    Article  PubMed  Google Scholar 

  4. Agha A, Benseler V, Hornung M et al (2014) Long-term oncologic outcome after laparoscopic surgery for rectal cancer. Surg Endosc 28:1119–1125

    Article  PubMed  Google Scholar 

  5. Anthuber M, Fürst A, Elser F et al (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46:1047–1053

    Article  PubMed  Google Scholar 

  6. Asoglu O, Matlim T, Karanlik H et al (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23:296–303

    Article  PubMed  Google Scholar 

  7. Bärlehner E, Benhidjeb T, Anders S et al (2005) Aktueller Stand der laparoskopischen Rektumresektion beim Karzinom. Chir Gastroenterol 21:54–61 Review

    Article  Google Scholar 

  8. Braga M, Frasson M, Vignali A et al (2005) Laparoscopic versus open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:217–223

    Article  Google Scholar 

  9. Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 18:CD005200 Review

    Google Scholar 

  10. Bonjer HJ, Cuesta MA, Lacy AM et al (2009) COLOR II A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Dan Med Bull 56:89–91

    PubMed  Google Scholar 

  11. Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  12. Collinson FJ, Jayne DG, Pigazzi A et al (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 27:233–241

    Article  PubMed  Google Scholar 

  13. Fazio VW, Zutshi M, Remi FH et al (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246:481–490

    Article  PubMed Central  PubMed  Google Scholar 

  14. Fürst A, Schwandner O, Heiligensetzer A et al (2010) Laparoscopic TME in rectal cancer – electronic supplementary: op-video. Langenbecks Arch Surg 395:181–183

    Article  PubMed Central  PubMed  Google Scholar 

  15. Guillou PJ, Quirke P, Thorpe H et al (2005) Short term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASSIC trail): multicentre randomized controlled trail. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  16. Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82

    Article  CAS  PubMed  Google Scholar 

  17. Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resction of colorectal carcinoma: 3-year results of th UK MRC CLASSIC Trial Group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  18. Kang SB, Park JW, Jeong SY et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol 11:637–645

    Article  PubMed  Google Scholar 

  19. Kuhry E, Schwenk WF, Gaupset R et al (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 16(2):CD003432 Review

    Google Scholar 

  20. Lacy AM, Garcia-Valdecasa JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  21. Leroy J, Jamali F, Forbes L et al (2003) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2:281–289

    Google Scholar 

  22. Liang JT, Lai HS, Lee PH (2007) Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy. Ann Surg Oncol 14:1285–1287

    Article  PubMed  Google Scholar 

  23. Lujan J, Valero G, Hernandez Q et al (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989

    Article  CAS  PubMed  Google Scholar 

  24. Morino M, Parini U, Giraudo G et al (2003) Laparoscopic total mesorectal excision. A consecutive series of 100 patients. Ann Surg 237:335–342

    PubMed Central  PubMed  Google Scholar 

  25. Ng SS, Leung KL, Lee JF et al (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425

    Article  PubMed  Google Scholar 

  26. Ng SS, Leung KL, Lee JF et al (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: ten-year results of an prospective, randomized trial. Dis Colon Rectum 52:558–566

    Article  PubMed  Google Scholar 

  27. Ng SS, Lee JF, Yiu RY et al (2014) Long-term oncologic outcomes of laparoscopic versus open surgery for rectal cancer: a pooled analysis of 3 randomized controlled trials. Ann Surg 259:139–147

    Article  PubMed  Google Scholar 

  28. Ohtani H, Tamamori Y, Azuma T et al (2011) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J Gastrointest Surg 15:1375–1385

    Article  PubMed  Google Scholar 

  29. Pas MH van der, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  PubMed  Google Scholar 

  30. Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89:1551–1556

    Article  CAS  PubMed  Google Scholar 

  31. Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery – current status and controversies. J Minim Access Surg 7:6–16

    PubMed Central  PubMed  Google Scholar 

  32. Shapiro R, Vogel JD, Kiran RP (2011) Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum 54:1496–1502

    Article  PubMed  Google Scholar 

  33. Ströhlein MA, Grützner KU, Jauch KW, Heiss MM (2008) Comparison of laparoscopic vs. open access surgery in patients with rectal cancer: a prospective analysis. Dis Colon Rectum 51:385–391

    Article  PubMed  Google Scholar 

  34. Tang CL, Eu KW, Tai BC et al (2001) Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg 88:801–807

    Article  CAS  PubMed  Google Scholar 

  35. Araujo SE, Silva eSousa AH da Jr, Campos FG de et al (2003) Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial. Rev Hosp Clin Fac Med Sao Paulo 58:133–140

    Article  PubMed  Google Scholar 

  36. Baik SH, Gincherman M, Mutch MG et al (2011) Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Dis Colon Rectum 54:6–14

    Article  PubMed  Google Scholar 

  37. Arteaga González I, Díaz Luis H, Martín Malagón A et al (2006) A comparative clinical study of short-term results of laparoscopic surgery for rectal cancer during the learning curve. Int J Colorectal Dis 21:590–595

    Article  Google Scholar 

  38. Park IJ, Choi GS, Lim KH et al (2009) Laparoscopic resection of extraperitoneal rectal cancer: a comparative analysis with open resection. Surg Endosc 23:1818–1824. DOI 10.1007/s00464-008-0265-6

    Article  PubMed  Google Scholar 

  39. Zhou ZG, Hu M, Li Y et al (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Fürst, A. Heiligensetzer, P. Sauer und G. Liebig-Hörl geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral-, Thoraxchirurgie, Caritas-Krankenhaus St. Josef, Landshuterstr. 65, 93053, Regensburg, Deutschland

    A. Fürst, A. Heiligensetzer, P. Sauer & G. Liebig-Hörl

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  1. A. Fürst
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  2. A. Heiligensetzer
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  3. P. Sauer
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  4. G. Liebig-Hörl
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Correspondence to A. Fürst.

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Fürst, A., Heiligensetzer, A., Sauer, P. et al. Evidenzlage der laparoskopischen Chirurgie beim Rektumkarzinom. Chirurg 85, 578–582 (2014). https://doi.org/10.1007/s00104-014-2743-9

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