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Aktuelle Behandlungsstrategien beim Rektumkarzinom

Present treatment strategies for rectal carcinoma

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Zusammenfassung

In der Therapie des primären Rektumkarzinoms sind in den letzten 10 Jahren erhebliche Fortschritte erzielt worden. Durch Verbesserung des interdisziplinären präoperativen Stagings mit detaillierter histopathologischer Beurteilung der Tumorbiopsie werden Rektumkarzinome stadienabhängig einem differenzierten Behandlungskonzept zugeführt: „low-risk“-pT1-(G1/G2)-Karzinome werden lokal per Vollwandexzision und „high-risk“-pT1-(G3/G4)-Karzinome sowie pT2-Karzinome transabdominell kurativ operiert. Demgegenüber ist bei allen primär als cUICC-II/-III-Stadien (T3/T4 oder N+) eingeschätzten Rektumkarzinomen aufgrund der exzellenten Ergebnisse der CAO/AIO/ARO-94-Studie der German Rectal Cancer Study Group eine neoadjuvante Radio-/Chemotherapie (mit 5-FU als Radiosensitizer) indiziert. Anschließend erfolgen die qualitätsgesicherte Resektion nach onkologischen Radikalitätsprinzipien [“No-touch-Technik“, radikuläre Gefäßabsetzung, totale Mesorektumexzision (TME) etc.] und die weitere adjuvante Chemotherapie. Durch derartige multimodale Therapiekonzepte sind erstmals auch bei fortgeschrittenen Rektumkarzinomen 5-Jahres-Lokalrezidivraten von 6% bei einem tumorfreien Überleben von 68% zu erreichen (Gesamtüberleben: 76%).

Abstract

In the last ten years, considerable progress has been achieved in the treatment of rectal cancer. According to improved interdisciplinary staging, rectal carcinomas can be treated based on a stage-dependent concept: “low-risk” pT1 (G1/G2) carcinomas can be cured by local full wall excision, while “high-risk” pT1 (G3/G4) and pT2 carcinomas require transabdominal resection. In contrast, locally advanced rectal cancers in cUICC-II/-III stages (T3/T4 or N+) should receive long-term, 5-FU-based, neoadjuvant chemoradiotherapy according to the excellent results of the CAO/AIO/ARO-94 trial of the German Rectal Cancer Study Group. High-quality resection must be based on radical oncologic principles such as “no-touch” technique, radicular dissection of vessels, and total mesorectal excision. Multimodal treatment is completed with adjuvant 5-FU-based chemotherapy. This therapeutic approach led to a reduction in the 5-year local recurrence rate to 6% and disease-free survival of approximately 68% in advanced rectal cancer (overall survival: 76%).

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  1. Klinik für Allgemeinchirurgie, Universitätsklinikum Göttingen

    T. Liersch, C. Langer, B. M. Ghadimi &  H. Becker

  2. Klinik für Allgemeinchirurgie, Universitätsklinikum Göttingen, Robert-Koch-Straße 40, 37099 , Göttingen

    H. Becker

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Liersch, T., Langer, C., Ghadimi, B.M. et al. Aktuelle Behandlungsstrategien beim Rektumkarzinom. Chirurg 76, 309–334 (2005). https://doi.org/10.1007/s00104-005-1005-2

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