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Zentralbl Chir 2001; 126(4): 283-288
DOI: 10.1055/s-2001-14799
Evidenz-basierte kolorektale Chirurgie

J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG

Evidence-based Chirurgie des Kolonkarzinoms

Evidence-based surgery of colon carcinomaI. Gastinger, F. Marusch
  • Chirurgische Klinik (Chefarzt: Prof. Dr. I. Gastinger), Carl-Thiem-Klinikum Cottbus
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Publication History

Publication Date:
31 December 2001 (online)

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Evidence-based surgery of colon carcinoma

Summary

Only a few therapeutic approaches in colon cancer therapy are based on controlled study results. Via an internet search using different search strategies 965 abstracts written about colon cancer therapy between 1980-2000 were analysed. Studies focussing on adjuvant therapy were not included. We found 446 retrospective, 150 prospective randomized, 151 prospective non-randomized studies and 218 review articles. Controlled study results as a scientific base are available for perioperative antibiotic prophylaxis (127 prospective randomized studies), mechanical intestinal cleansing (n = 5), a similar efficacy of stapler and hand-made anastomosis (n = 15), and the early onset of a stage-adjusted nutrition (n = 3). Our internet search shows that only a minor fraction (approximately 10 %) of colon surgery is evidence based. The most important prerequisites for an appropriate surgical resection are the pathology results reflecting the degree of tumor spreading. Besides the data from controlled studies we have to take the results from prospective multi-center studies in consideration.

Zusammenfassung

Nur ein geringer Teil der Behandlung des Kolonkarzinoms ist durch kontrollierte Studiendaten abgesichert. Durch eine Internetrecherche mit verschiedenen Suchstrategien zur Chirurgie des Kolonkarzinoms wurden 965 Abstracts des Zeitraumes 1980-2000 ausgewertet. Nicht berücksichtigt wurden Arbeiten zur adjuvanten Therapie. Es fanden sich 446 retrospektive, 150 prospektiv randomisierte, 151 prospektive nicht randomisierte Studien und 218 Übersichtsarbeiten. Durch kontrollierte Studiendaten abgesichert sind die perioperative Antibiotikaprophylaxe (127 prospektiv randomisierte Studien), die mechanische Darmreinigung (n = 5), die prinzipielle Gleichwertigkeit von Stapler- und Handanastomosen (n = 15) und der frühzeitige Kostaufbau (n = 3). Die Recherche zeigt, dass nur ein geringer Teil der Chirurgie des Kolonkarzinoms (etwa 10 %) evidenzbasiert erfolgt. Wichtigste Grundlage für eine adäquate Resektionstechnik bilden nach wie vor die pathohistologischen Erkenntnisse über die Tumorausbreitung. Neben den Daten kontrollierter Studien müssen die Ergebnisse aus prospektiven multizentrischen Beobachtungsstudien unbedingt Berücksichtigung finden.

Key words

Evidence-based surgery - colon carcinoma - surgery - prospective multi-center studies

Schlüsselwörter

Evidence-based medicine - Kolonkarzinom - Chirurgie - prospektive Multizenterstudien

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Prof. Dr. I. Gastinger

Chirurgische Klinik
Carl-Thiem-Klinikum

Thiemstraße 111

D-03048 Cottbus







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