Z Gastroenterol 2013; 51(8): 753-854
DOI: 10.1055/s-0033-1350264
Leitlinie
© Georg Thieme Verlag KG Stuttgart · New York

S3-Leitlinie Kolorektales Karzinom Version 1.0 – Juni 2013 AWMF-Registernummer: 021/007OL

S3-Guideline Colorectal Cancer Version 1.0
C. Pox
1   Medizinische Klinik, Knappschaftskrankenhaus GmbH Bochum, Ruhr-Universität Bochum, Bochum
,
S. Aretz
2   Institut für Humangenetik, Universitätsklinik Bonn, Bonn
,
S. C. Bischoff
3   Institut f. Ernährungsmedizin/Prävention Universität Hohenheim, Stuttgart
,
U. Graeven
4   Medizinische Klinik I, Krankenhaus St. Franziskus, Mönchengladbach
,
M. Hass
5   Deutsche ILCO e.V., Bonn
,
P. Heußner
6   Medizinische Klinik und Poliklinik III, Klinikum der Universität München, München
,
W. Hohenberger
7   Chirurgische Klinik, Universitätsklinikum Erlangen, Erlangen
,
A. Holstege
8   Medizinische Klinik I, Klinikum Landshut gGmbH, Landshut
,
J. Hübner
9   Komplementäre Onkologie, Centrum für Tumorerkrankungen J. W. Goethe-Universität, Frankfurt
,
F. Kolligs
10   Medizinische Klinik und Poliklinik II, Klinikum der Universität München, München
,
M. Kreis
11   Chirurgische Klinik I, Charité- Universität Berlin, Campus Benjamin Fränklin, Berlin
,
P. Lux
7   Chirurgische Klinik, Universitätsklinikum Erlangen, Erlangen
,
J. Ockenga
12   Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen
,
R. Porschen
13   Medizinische Klinik, Klinikum Bremen-Ost, Bremen
,
S. Post
14   Chirurgische Klinik, Universitätsklinikum Mannheim GmbH, Mannheim
,
N. Rahner
15   Institut f. Humangenetik u. Anthropologie, Heinrich Heine Universität, Düsseldorf
,
A. Reinacher-Schick
16   Abteilung für Hämatologie/Onkologie, St. Josef Hospital Bochum, Ruhr-Universität Bochum, Bochum
,
J. F. Riemann
17   Stiftung Lebensblicke, Ludwigshafen
,
R. Sauer
18   Strahlenklinik, Universität Erlangen/Nürnberg, Erlangen
,
A. Sieg
19   Gastroenterologische Schwerpunktpraxis, Heidelberg
,
W. Scheppach
20   Gastroenterologische Klinik, Stiftung Juliusspital Würzburg, Würzburg
,
W. Schmitt
21   I. Med. Abteilung, Städtisches Krankenhaus München-Neuperlach, München
,
H. J. Schmoll
22   Klinik und Poliklinik für Innere Medizin IV, Universität Halle, Halle
,
K. Schulmann
23   Klinik für Innere Medizin, Klinikum Arnsberg, St. Johannes-Hospital, MVZ Arnsberg
,
A. Tannapfel
24   Pathologisches Institut der Ruhr Universität Bochum, Bochum
,
W. Schmiegel
1   Medizinische Klinik, Knappschaftskrankenhaus GmbH Bochum, Ruhr-Universität Bochum, Bochum
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
16. August 2013 (online)

1. Informationen zu dieser Leitlinie

1.1. Herausgeber

Leitlinienprogramm Onkologie der AWMF, Deutschen Krebsgesellschaft e. V. und Deutschen Krebshilfe e. V.


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1.2. Federführende Fachgesellschaft

Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

Steuerungsgruppe für Planung und Durchführung über DGVS:
Univ.-Prof. Dr. Wolff Schmiegel
Dr. Christian P. Pox


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1.3. Finanzierung der Leitlinie

Diese Leitlinie wurde von der Deutschen Krebshilfe im Rahmen des Onkologischen Leitlinienprogramms gefördert.


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1.4. Kontakt

Leitlinienprogramm Onkologie Office
c/o Deutsche Krebsgesellschaft e. V.
Kuno-Fischer-Str. 8
14 057 Berlin

leitlinienprogramm@krebsgesellschaft.de
www.leitlinienprogramm-onkologie.de


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1.5. Zitierweise

Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 1.0, AWMF Registernummer: 021 – 007OL, http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html


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1.6. Besonderer Hinweis

Die Medizin unterliegt einem fortwährenden Entwicklungsprozess, sodass alle Angaben, insbesondere zu diagnostischen und therapeutischen Verfahren, immer nur dem Wissensstand zurzeit der Drucklegung der Leitlinie entsprechen können. Hinsichtlich der angegebenen Empfehlungen zur Therapie und der Auswahl sowie Dosierung von Medikamenten wurde die größtmögliche Sorgfalt beachtet. Gleichwohl werden die Benutzer aufgefordert, die Beipackzettel und Fachinformationen der Hersteller zur Kontrolle heranzuziehen und im Zweifelsfall einen Spezialisten zu konsultieren. Fragliche Unstimmigkeiten sollen bitte im allgemeinen Interesse der OL-Redaktion mitgeteilt werden.

Der Benutzer selbst bleibt verantwortlich für jede diagnostische und therapeutische Applikation, Medikation und Dosierung.

In dieser Leitlinie sind eingetragene Warenzeichen (geschützte Warennamen) nicht besonders kenntlich gemacht. Es kann also aus dem Fehlen eines entsprechenden Hinweises nicht geschlossen werden, dass es sich um einen freien Warennamen handelt.

Das Werk ist in allen seinen Teilen urheberrechtlich geschützt. Jede Verwertung außerhalb der Bestimmung des Urhebergesetzes ist ohne schriftliche Zustimmung des Leitlinienprogramms Onkologie (OL) unzulässig und strafbar. Kein Teil des Werkes darf in irgendeiner Form ohne schriftliche Genehmigung des OL reproduziert werden. Dies gilt insbesondere für Vervielfältigungen, Übersetzungen, Mikroverfilmungen und die Einspeicherung, Nutzung und Verwertung in elektronischen Systemen, Intranets und dem Internet.


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1.7. Ziele des Leitlinienprogramms Onkologie

Die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., die Deutsche Krebsgesellschaft e. V. und die Deutsche Krebshilfe e. V. haben sich mit dem Leitlinienprogramm Onkologie (OL) das Ziel gesetzt, gemeinsam die Entwicklung und Fortschreibung und den Einsatz wissenschaftlich begründeter und praktikabler Leitlinien in der Onkologie zu fördern und zu unterstützen. Die Basis dieses Programms beruht auf den medizinisch-wissenschaftlichen Erkenntnissen der Fachgesellschaften und der DKG, dem Konsens der medizinischen Fachexperten, Anwender und Patienten sowie auf dem Regelwerk für die Leitlinienerstellung der AWMF und der fachlichen Unterstützung und Finanzierung durch die Deutsche Krebshilfe. Um den aktuellen Stand des medizinischen Wissens abzubilden und den medizinischen Fortschritt zu berücksichtigen, müssen Leitlinien regelmäßig überprüft und fortgeschrieben werden. Die Anwendung des AWMF-Regelwerks soll hierbei Grundlage zur Entwicklung qualitativ hochwertiger onkologischer Leitlinien sein. Da Leitlinien ein wichtiges Instrument der Qualitätssicherung und des Qualitätsmanagements in der Onkologie darstellen, sollten sie gezielt und nachhaltig in den Versorgungsalltag eingebracht werden. So sind aktive Implementierungsmaßnahmen und auch Evaluationsprogramme ein wichtiger Bestandteil der Förderung des Leitlinienprogramms Onkologie. Ziel des Programms ist es, in Deutschland professionelle und mittelfristig finanziell gesicherte Voraussetzungen für die Entwicklung und Bereitstellung hochwertiger Leitlinien zu schaffen. Denn diese hochwertigen Leitlinien dienen nicht nur dem strukturierten Wissenstransfer, sondern können auch in der Gestaltung der Strukturen des Gesundheitssystems ihren Platz finden. Zu erwähnen sind hier evidenzbasierte Leitlinien als Grundlage zum Erstellen und Aktualisieren von Disease Management Programmen oder die Verwendung von aus Leitlinien extrahierten Qualitätsindikatoren im Rahmen der Zertifizierung von Organtumorzentren.


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1.8. Autoren dieser Leitlinie

C. Pox, S. Aretz, S. C. Bischoff, U. Graeven, M. Hass, P. Heußner, W. Hohenberger, A. Holstege, J. Hübner, F. Kolligs, M. Kreis, P. Lux, J. Ockenga, R. Porschen, S. Post, N. Rahner, A. Reinacher-Schick, J. F. Riemann, R. Sauer, A. Sieg, W. Scheppach, W. Schmitt, H.-J. Schmoll, K. Schulmann, A. Tannapfel, W. Schmiegel

1.8.1. Zusammensetzung der Leitliniengruppe 2011/2012

Die Fachexpertengruppe für die Aktualisierung der Kapitel 3, 4, 5, 7, 10 (s. Abschnitt 2.2.1) setzte sich aus insgesamt 53 Mandatsträgern und Plenumsmitgliedern folgender Fachgesellschaften, Berufsverbände und Patientenvereinigungen zusammen:

  • Fachgesellschaften

    • DKG (Deutsche Krebsgesellschaft)

      • ASORS (AG der DKG „Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin“)

      • PRIO (AG der DKG Prävention und integrative Medizin in der Onkologie)

      • PSO (AG der DKG: Dt. Arbeitsgemeinschaft für Psychoonkologie)

    • KOK (AG der DKG: Konferenz Onkologische Kranken- und Kinderkrankenpflege)

    • DGVS (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten)

    • DEGAM (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin)

    • DEGRO (Deutsche Gesellschaft für Radioonkologie)

    • DGAV (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie)

      • CACP (Chirurgische Arbeitsgemeinschaft für Colo-Proktologie)

      • CAMIC (Chirurgische Arbeitsgemeinschaft für Minimal-invasive Chirurgie)

      • CAO-V (Chirurgische Arbeitsgemeinschaft für Onkologie)

    • DGCH (Deutsche Gesellschaft für Chirurgie)

    • DGEM (Deutsche Gesellschaft für Ernährungsmedizin)

    • DGHO (Deutsche Gesellschaft für Hämatologie und Onkologie)

    • DGIM (Deutsche Gesellschaft für Innere Medizin)

    • DGKL (Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin)

    • DGN (Deutsche Gesellschaft für Nuklearmedizin)

    • DGP (Deutsche Gesellschaft für Pathologie)

    • DRG (Deutsche Röntgengesellschaft)

    • GfH (Deutsche Gesellschaft für Humangenetik)

  • andere Institutionen

    • bng (Berufsverband Niedergelassener Gastroenterologen Deutschlands e. V.)

    • HÄV (Deutscher Hausärzteverband)

    • AQUA (Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen)

    • ZI (Zentralinstitut der Kassenärztlichen Versorgung in der BRD)

    • Felix-Burda-Stiftung

    • Stiftung Lebensblicke

  • Patientenvereinigungen

    • DCCV (Deutsche Morbus Crohn/Colitis Ulcerosa Vereinigung)

    • Deutsche ILCO (Vereinigung für Stomaträger und für Menschen mit Darmkrebs)

[Tab. 1] zeigt die Zusammensetzung der Leitliniengruppe 2011/2012 unter der Leitung von Prof. Dr. W. Schmiegel (DKG, DGVS)

Tab. 1

Zusammensetzung der Arbeitsgruppen für die Aktualisierung der Kapitel 3, 4, 5, 7, 10.

Kapitel 3: Prävention asymptomatische Bevölkerung

Koordinator: J. F. Riemann

DGIM, DGVS, Stiftung Lebensblicke

Mitglieder:

S. C. Bischoff


DGEM, DGVS

F. Kolligs

DGVS

J. Ockenga

DGEM, DGVS

W. Scheppach

DGEM, DGVS

Kapitel 4: Früherkennung/Vorsorge asymptomatische Bevölkerung

Koordinatoren: C. Pox, A. Sieg

beide DGVS

Mitglieder:

L. Altenhofen


ZI

H-J. Brambs

DRG, DGAM

H. Brenner

Experte (nicht stimmberechtigt)

P. Engeser

HÄV

A. Theilmeier

bng, DGVS

Kapitel 5: Risikogruppen

Koordinatoren:

N. Rahner

K. Schulmann


GfH

DGVS

G. Baretton

DGP

B. Bokemeyer

bng, DGVS

J. Epplen

DGHG

U. Melle

DGVS

R. Porschen

DGVS

J. Weitz

DGAV

C. Witte

DCCV

Kapitel 7: Präoperative Diagnostik und Chirurgie

Koordinatoren:

W. Hohenberger

S. Post


DKG, DGAV

DKG, DGAV, CACP

M. Anthuber

DGAV

W. Bechstein

DGAV

U. Graeven

DGVS

M. Haß

Dt. ILCO

M. Heike

DGHO

K.-W. Jauch

DGAV

T. Kirchner

DGP

H. Lang

DKG, DGAV, CAO-V

K-H. Link

DKG, DGAV

P. Pereira

DRG

H-R. Raab

DGAV

A. Reinacher-Schick

DGVS

C. Rödel

DEGRO

M. Sailer

DGAV

R. Sauer

DEGRO

K. Scheidhauer

DGN

A. Tannapfel

DGP

T. Vogl

DRG

C. Wagener

DGKL

M. Walz

DGAV, CAMIC

C. Wittekind

DGP

Kapitel 10: Nachsorge

Koordinator: A. Holstege

DGVS

Mitglieder:

P. Heußner


PSO

T. Höhler

DGHO

J. Hübner

DKG, PRIO

J. Körber

DKG, ASORS

M. Landenberger

DKG, KOK

H. Link

DKG, ASORS

Zusätzlich beim Plenum beteiligt

S. Ludt

AQUA

P. Lux

Mit-Autor (nicht stimmberechtigt)

C. Maar

Felix-Burda-Stiftung


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1.8.2. Koordinatoren der Leitliniengruppe 2007/2008

Die Koordinatoren bei der Überarbeitung der Kapitel 6, 8 und 9 in 2007/2008 waren:

Kapitel 6 – Endoskopie: Durchführung und Polypenmanagement:
J. F. Riemann, W. Schmitt

Kapitel 8 – Adjuvante und neoadjuvante Therapie:
R. Porschen, R. Sauer

Kapitel 9 – Therapeutisches Vorgehen bei Metastasierung und in der palliativen Situation: U. Graeven, H-J. Schmoll


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1.8.3. Zusammensetzung der AG Qualitätsindikatoren

Die Entwicklung der Vorschläge zu Qualitätsindikatoren erfolgte durch die in [Tab. 2] aufgeführte Arbeitsgruppe.

Tab. 2

Zusammensetzung der AG Qualitätsindikatoren.

Name

Institution

Koordinatoren:

W. Schmiegel

C. Pox


DKG, DGVS

DGVS

Mitglieder:

M. Haß


Dt. ILCO

W. Hohenberger

DKG, DGAV

A. Holstege

DGVS

F. Kolligs

DGVS

M. Klinkhammer-Schalke

Arbeitsgemeinschaft Deutscher Tumorzentren (ADT)

I. Kopp

AWMF, Leitlinienprogramm Onkologie

S. Ludt

AQUA

J. Ockenga

DGVS

S. Post

DKG, DGAV, CACP

A. Tannapfel

DGP

S. Wesselmann

Deutsche Krebsgesellschaft (DKG), Bereich Zertifizierung


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1.8.4. Methodische Begleitung

Durch das Leitlinienprogramm Onkologie:

  • Prof. Dr. Ina Kopp (AWMF), Marburg

  • Dr. Markus Follmann, MPH MSc (DKG), Berlin


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1.9. Verfügbare Dokumente zur Leitlinie und Implementierung

Bei diesem Dokument handelt es sich um die Langversion der S3-Leitlinie Kolorektales Karzinom, welche über die folgenden Seiten zugänglich ist:

Darüber hinaus wird die Langversion dieser Leitlinie wird in der Zeitschrift für Gastroenterologie veröffentlicht werden.

Neben der Langfassung wird es die folgenden ergänzenden Dokumente zu dieser Leitlinie geben:

  • Kurzversion

  • Leitlinienreport

  • Übersetzung (englisch)

  • Patientenleitlinie

  • Externer Evidenzbericht

Alle diese Dokumente werden ebenfalls auf den oben genannten Homepages abrufbar sein.

Der externe Evidenzbericht wurde zum Kapitel 4 (Vorsorge/Früherkennung) und Teilen des Kapitels 7 (präoperative Diagnostik und Chirurgie) von einer Kooperation der Universität Witten/Herdecke (Institut für Forschung in der Operativen Medizin) mit der Universität Duisburg/Essen (Alfried Krupp von Bohlen und Halbach Stiftungslehrstuhl für Medizinmanagement) erstellt.

Die Erstellung der Patientenleitlinie und die Übersetzung der Langversion ins Englische werden mit Fertigstellung der Leitlinie in Auftrag gegeben.

Eine flächendeckende Verbreitung dieser evidenzbasierten, aktuellen Verhaltensempfehlungen ist insbesondere für die Steigerung der Qualität bei Patienteninformation und -versorgung notwendig. Mithilfe standardisierter Methoden wurden von den Empfehlungen Qualitätsindikatoren abgeleitet. Diese dienen neben der Implementierung in erster Linie der Qualitätssicherung und -steigerung der patientenrelevanten Prozesse.


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