Optimale präoperative Diagnostik beim Rektumkarzinom

Zusammenfassung

Ziel der präoperativen Diagnostik beim Rektumkarzinom ist die Erfassung des Ausmaßes der lokalen und systemischen Tumorausbreitung. Das lokale Staging umfasst die Rektoskopie mit exakter Höhenlokalisation, die histologische Sicherung, die MRT des Beckens und – insbesondere bei lokal begrenzten Tumoren – die Endosonografie. Die Befundung der MRT sollte neben der Höhe des Tumors und der möglichen Infiltration von Nachbarorganen den minimalen Abstand des Tumors zur mesorektalen Faszie enthalten. Wichtig ist zudem die Angabe MR-morphologischer Kriterien extramuraler Gefäßinvasion. Bei tiefen Karzinomen ist der Bezug zu den einzelnen Komponenten des Schließmuskels eine wichtige Frage an die MRT zur Planung der operativen Strategie, bei hohen Karzinomen sollte auf eine mögliche Infiltration der peritonealen Umschlagfalte geachtet werden. Zum Nachweis oder Ausschluss von Fernmetastasen stellt ein Röntgenthorax und eine Sonografie des Abdomens die durch die Leitlinie geforderte Basisdiagnostik dar. Entweder primär, in jedem Fall aber bei unklaren Befunden, sollten diese durch ein Thorax- und Abdomen-CT ergänzt werden. Neben der Bestimmung des karzinoembryonalen Antigens (CEA), das vorrangig zur Verlaufskontrolle dient, sollte eine vollständige Koloskopie zum Ausschluss eines Zweitmalignoms im Kolon erfolgen. Ist diese aufgrund eines nicht passierbaren Tumors nicht möglich, dann sollte diese 3 Monate postoperativ erfolgen. Ergänzend kann eine präoperative CT- oder MR-Kolonoskopie erfolgen, mit der größere Polypen und Karzinome nachgewiesen werden können.

Abstract

Preoperative diagnostics for rectal cancer aim to determine the extent of local and systemic spread. Local staging includes rectoscopy with accurate height localisation, histological confirmation, MRI of the pelvis and, particularly in the case of localised tumours, endosonography. In addition to tumour height and possible infiltration of adjacent organs, MRI findings should include minimum tumour distance from the mesorectal fascia and MR morphological criteria for extramural vascular invasion. In the case of lower rectal cancer, the relationship to the various components of the sphincter muscle is important in planning the surgical strategy; in the case of upper rectal cancer, the MRI findings should include possible infiltration of the peritoneal fold. As outlined in the German guidelines, the basic diagnostic tests required to detect or exclude distant metastases are a chest X-ray and an abdominal ultrasound. If unclear findings are observed, these should be supplemented by a chest and abdominal CT. In addition to the carcinoembryonic antigen (CEA) test, which is primarily used for follow-up, a complete colonoscopy should be performed to rule out a second malignancy in the colon. If this is not possible due to an obstructive tumour, the colonoscopy should be performed three months postoperatively. Additionally, a preoperative CT or MR colonoscopy can reliably detect larger polyps and carcinomas.

Schlüsselwörter

Rektumresektion - Rektumkarzinom - MRT - bildgebende Verfahren - Krebs

Keywords

colon surgery - colorectal carcinoma - MRI - imaging methods - cancer

Publication History

Received: 27 January 2025

Accepted after revision: 10 March 2025

Article published online:
08 April 2025

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