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Organerhalt Rektum

Welche Auswirkungen hat er auf die Lebensqualität?

Organ preservation in rectal cancer

What is the impact on the quality of life?

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coloproctology Aims and scope

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Zusammenfassung

Mit der zunehmenden Verbesserung der onkologischen Ergebnisse bei der kurativen Behandlung des Rektumkarzinoms durch Individualisierung und Optimierung der einzelnen Komponenten der multimodalen Therapie ist die Bedeutung der funktionellen Einschränkungen durch Resektion des Organs und Bestrahlung des Umfelds für die Lebensqualität der Patienten in den letzten Jahren in den Fokus gerückt. Neben einem schonenden operativen Vorgehen und verbesserter Bestrahlungsplanung bei radikal-chirurgischen Therapien ermöglichen die Konzepte der lokalen Exzision und des Beobachtens und Abwartens („watch and wait“) nach Radiochemotherapie (RCT) für einen Teil der Patienten den Organerhalt mit Aussicht auf eine erhaltene Funktion ohne Einbuße der onkologischen Sicherheit. Das Ausmaß struktureller Veränderungen des Gewebes durch lokal-chirurgische Maßnahmen und Bestrahlung sowie deren Folgen auf die funktionellen Ergebnisse zeigen im Vergleich zur mesorektalen Exzision mit Organverlust eine geringere Ausprägung und wirken sich positiv auf die Lebensqualität aus. Dennoch werden auch nach lokaler Exzision und Radiochemotherapie im Rahmen eines Watch-and-wait-Konzeptes mitunter schwere funktionelle Störungen mit entsprechender Einschränkung der Lebensqualität beobachtet, die eine Stomaanlage notwendig machen können.

Abstract

The curative treatment of rectal cancer by individualization and optimization of the individual components of multimodal treatment of rectal cancer, has led to increasing improvements in the oncological results. As a result, in recent years the importance of functional limitations on the quality of life due to resection of the rectum and irradiation of the surrounding tissue has become a focus of attention. In addition to the sparing operative procedure and improved planning of irradiation in radical surgical treatment, for selected patients the concepts of local excision and watch and wait following chemoradiotherapy enable organ preservation with the prospect of retained function without relinquishing oncological safety. The extent of structural alterations of the tissue by local surgical measures and irradiation and the impact on the functional outcome are significantly reduced compared to mesorectal excision with loss of the organ and have a positive effect on the quality of life; however, even local excision and chemoradiotherapy combined with a watch and wait concept is sometimes associated with severe functional disorders with corresponding impairments of the quality of life, which can necessitate the placement of a stoma.

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Authors and Affiliations

  1. Chirurgische Abteilung, Krankenhaus der Barmherzigen Brüder Graz, Graz, Österreich

    Felix Aigner

  2. Klinik für Allgemein- und Viszeralchirurgie, St. Joseph Krankenhaus Berlin-Tempelhof GmbH, Wüsthoffstr. 15, 12101, Berlin, Deutschland

    Jörn Gröne

  3. Klinik für Allgemein- und Viszeralchirurgie, St. Georg Klinikum Eisenach, Eisenach, Deutschland

    Werner Kneist

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  1. Felix Aigner
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  2. Jörn Gröne
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Correspondence to Jörn Gröne.

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Interessenkonflikt

F. Aigner, J. Gröne und W. Kneist geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Aigner, F., Gröne, J. & Kneist, W. Organerhalt Rektum. coloproctology 42, 324–330 (2020). https://doi.org/10.1007/s00053-020-00468-3

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