Körperliche Aktivität und Ernährung in der Prävention und Therapie des Kolorektalen Karzinoms^[*]

Zusammenfassung

Hintergrund Kolorektale Karzinome sind eine der häufigsten Krebserkrankungen in Europa. Moderne Therapieformen verbessern die Überlebenschancen; trotzdem sind die Erkrankung und ihre Behandlung mit einer hohen Morbidität verbunden. Körperliche Aktivität (KA) hat offensichtlich einen positiven Einfluss auf das Erkrankungsrisiko, die perioperative Komplikationsrate und die adjuvante Therapie.

Methode Grundlage für diese narrative Übersicht ist eine selektive Literatursuche in der Datenbank PubMed, ergänzt durch eine Suche in GoogleScholar bis 30.09.2022. Eingeschlossen wurden Originalarbeiten, Metaanalysen und systematische Reviews. Studien, die Bewegung und Ernährung analysierten, wurden ebenso berücksichtigt wie Leitlinien und Positionspapiere der deutschen, europäischen und amerikanischen Fachgesellschaften.

Ergebnisse Ein körperlich aktiver Lebensstil trägt über epigenetische Mechanismen zur Reduktion des Kolonkrebsrisikos bei. Je nach Studienprotokoll und Dosis der körperlichen Aktivität sind Risikoreduktionen zwischen 12 und 27 Prozent dokumentiert. Eine Prehabilitation aus Ernährung, Bewegung und psychologischer Unterstützung kann die peri- und postoperativen Ergebnisse beim kolorektalen Karzinom verbessern. Ausdauer- und Krafttraining können das rezidivfreie Überleben und die Tumorsterblichkeit verbessern. Keine Studie konnte eindeutige Verbesserungen bei Symptomabfragen (z.B. Fatigue) oder Biomarkern durch eine Ernährungsumstellung zeigen.

Schlussfolgerung Trotz einer Vielzahl an wissenschaftlichen Untersuchungen sind viele Fragen zum Einfluss von kA auf die verschiedenen Phasen einer Kolonkarzinomerkrankung nicht hinreichend geklärt. Empfehlungen zur Prehabilitation und zur Tertiärprophylaxe können aktuell nur auf Basis heterogener Studiendaten gegeben werden.

Abstract

Introduction Colorectal carcinoma is a leading cause of cancer diseases in Europe. Due to modern therapies survival rate is increasing. Nevertheless, cancer and its treatment is associated with significant morbidity. Physical activity appears as having a positive impact on cancer risk, as well as, reducing peri- and postoperative morbidity and mortality.

Methods We searched pubmed and googlescholar for English- and German-language studies from inception to September 2022. The search terms physical activity, colon cancer, colorectal cancer, diet, survivors. prehabilitation, postoperative morbidity, quality of life and outcome were used. Guidelines of national advisory commmittees and Cochrane reviews were included.

Results There is considerable evidence that physical activity is associated with reduced risk of colon cancer, epigenetic mechanisms play a central role in connection. Different studies showed a risk reduction of 12 to 27 percent. A prehabilitation programme consisting of exercise, nutritional intervention, and psychosocial rehabilitation can reduce peri- and postoperative complications. Aerobic exercise and strength training can improve survival rates and overall mortality. However, a causal relationship between nutritional treatment and cancer related symptoms (e.g. fatigue) is missing.

Conclusion There is a wide range of scientific papers on the influence of physical activity and nutrition; nevertheless, its influence on the various stages of colorectal disease are not addressed adequately. Recommendations concerning prehabilitation and tertiary prevention can only be given on the basis of heterogeneous trial data.

Schlüsselwörter

körperliche Aktivität - kolorektales Karzinom - Prähabilitation - postoperatives Ergebnis

Keywords

physical activity - colorectal cancer - prehabilitation - postoperative outcome

^* Gewidmet dem Vorsitzenden der Stiftung Lebensblicke, Herrn Prof. Dr. Jürgen F. Riemann anlässlich seines 80. Geburtstages.

Publication History

Received: 19 December 2022

Accepted after revision: 24 May 2023

Article published online:
10 July 2023

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