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Präoperatives Staging des Rektumkarzinoms

Preoperative staging of rectal cancer

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Zusammenfassung

Die präoperative Diagnostik des Rektumkarzinoms ist für das Patientenmanagement von Bedeutung, da die Behandlungsstrategien unmittelbar von der lokalen Tumorausdehnung, der regionalen Lymphknotensituation und dem Metastasierungsmuster abhängen.

Die Therapie und Diagnostik des Rektumkarzinoms wurde in den letzten Jahren studiengestützt und leitlinienorientiert weitgehend vereinheitlicht. Operativ hat sich, propagiert durch Heald, die totale mesorektale Exzision (TME) als standardisierte Technik zur En-bloc-Resektion des Rektums unter Mitnahme seiner Hüllfaszie durchgesetzt. Daneben spielt die neoadjuvante Radiochemotherapie fortgeschrittener Tumorstadien eine immer zentralere Rolle, wobei neue Chemotherapeutika zukünftig auf eine Verbesserung des onkologischen Outcomes hoffen lassen. Die exakte Visualisierung des zirkumferenziellen Resektionsrandes (CRM), der der mesorektalen Faszie entspricht, ist in der Primärdiagnostik des Rektumkarzinoms und für die Qualitätssicherung einer sauberen TME-Chirurgie heute Dreh- und Angelpunkt.

Ziel vorliegender Arbeit ist, das Interesse der Leser für die Schnittbilddiagnostik und hier insbesondere für die MRT beim Rektumkarzinom zu wecken und einen Ausblick auf innovative Techniken zu vermitteln.

Abstract

Accurate preoperative staging of rectal cancer is crucial for therapeutic decision making, as local tumor extent, nodal status, and patterns of metastatic spread are directly associated with different treatment strategies. Recently, treatment approaches have been widely standardized according to large studies and consensus guidelines. Introduced by Heald, total mesorectal excision (TME) is widely accepted as the surgical procedure of choice to remove the rectum together with its enveloping tissues and the mesorectal fascia. Neoadjuvant radiochemotherapy also plays a key role in the treatment of locally advanced stages, while the use of new drugs will lead to a further improvement in oncological outcome. Visualization of the circumferential resection margin is the hallmark of any preoperative imaging and a prerequisite for high-quality TME surgery. The aim of this article is to present an overview on current cross-sectional imaging with emphasis on magnetic resonance imaging. Future perspectives in rectal cancer imaging are addressed.

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Authors and Affiliations

  1. Abteilung Röntgendiagnostik, Radiologische Universitätsklinik Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Deutschland

    A.-O. Schäfer, T. Baumann, G. Pache & M. Langer

  2. Institut für Pathologie, Universitätsklinik Freiburg, Freiburg, Deutschland

    T. Wiech

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  1. A.-O. Schäfer
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  2. T. Baumann
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Correspondence to A.-O. Schäfer.

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Schäfer, AO., Baumann, T., Pache, G. et al. Präoperatives Staging des Rektumkarzinoms. Radiologe 47, 635–652 (2007). https://doi.org/10.1007/s00117-007-1516-6

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