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
Literatur
-
1
Abcarian H.
Operative treatment of colorectal cancer.
Cancer.
1992;
70
1350-1354
-
2
Anders A, Nordhausen B, Zeuschner Z, Fabrizius K.
Prevention of infections in surgery of the colon.
Zentralbl Chir.
1984;
109
1097-1106
-
3
Billingham R P.
Extended lymphadenectomy for rectal cancer: cure vs quality of life.
Int Surg.
1994;
79
11-22
-
4
Buyse M, Zeleniuch-Jacquotte A, Chalmers T C.
Adjuvant chemotherapy of colorectal cancer: why we still don't know.
JAMA.
1988;
259
3571-3578
-
5
Caplin S, Cerottini J P, Bosman F T, Constanda M T, Givel J C.
For patients with Dukes B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis.
Cancer.
1998;
83
666-672
-
6
Clinical outcome of surgical therapy (COST) study group .
Early results of laparoscopic surgery for colorectal cancer.
Dis Colon Rectum.
1996;
39 (Suppl 10)
S53-S58
-
7
Donati A, Zanghi G, Brancato G, Privitera A, Zanghi A.
The role of lymphadenectomy in colorectal neoplasms.
Minerva Chir.
1998;
53
993-999
-
8
Dube S, Heyen F, Jenicek M.
Adjuvant chemotherapy in colorectal carcinoma.
Dis Colon Rectum.
1997;
40
35-41
-
9
During M, Neff U, Rittmann W W, Leutenegger A, Oberholzer M, Wolff G.
Antibiotic prophylaxis in colon surgery with Cefazolin.
Helv Chir Acta.
1980;
46
721-726
-
10
Fielding L P, Phillips R K, Fry J S, Hittinger R.
Prediction of outcome after curative resection for large bowel cancer.
Lancet.
1986;
II
904-907
-
11
Franklin M E, Rosenthal D, Norem R F.
Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma.
Surg Endosc.
1995;
9
811-816
-
12
Fukatsu K, Saito H, Matsuda T, Ikeda S, Furukawa S, Muto T.
Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin-resistant Staphylococcus aureus and on the incidence of wound infection.
Arch Surg.
1997;
132
1320-1325
-
13 Gall F P, Zirngibl H, Hermanek P. Das kolorektale Karzinom. Zuckschwerdt, München, Bern, Wien 1989
-
14
Gall F P, Hermanek P.
Wandel und derzeitiger Stand der chirurgischen Behandlung des colorectalen Carcinoms.
Chirurg.
1992;
63
227-234
-
15
Gall F P, Tonak J, Altendorf A.
Multiviszeral resections in colorectal cancer.
Dis Colon Rectum.
1987;
30
337-341
-
16
Gall F P, Tonak J, Altendorf A, Kuruz U.
Operative tactics and results in extensive operations for colorectal cancer.
Langenbecks Arch Chir.
1985;
366
445-450
-
17
Gastinger I, Marusch F, Schneider C, Scheidbach H, Konradt J, Bruch H P, Köhler L, Bärlehner E, Köckerling F. Laparoscopic Colorectal Surgery Study Group (LCSSG) .
The importance of conversion for the results obtained with laparoscopic colorectal surgery.
Dis Colon Rectum.
2000;
44
207-216
-
18
Gebhardt C, Meyer W, Ruckriegel S, Meier U.
Multivisceral resection of advanced colorectal carcinoma.
Langenbecks Arch Surg.
1999;
384
194-199
-
19
Gray R, Northover J.
Adjuvant treatment for colorectal cancer.
Br Med J.
1996;
312
1417-1418
-
20
Herfarth C, Runkel N.
Chirurgische Standards beim primären Coloncarcinom.
Chirurg.
1994;
65
514-523
-
21
Hermanek P.
Multiviszerale Resektion beim kolorektalen Karzinom.
Langenbecks Arch Chir Suppl (Kongreßber).
1992;
95-100
-
22
Hermanek P, Gall F P.
Die Bedeutung der lokalen Kontrolle des kolorektalen Karzinoms.
Fortschr Med.
1985;
103
1041-1046
-
23
Hermanek P, Wiebelt H, Riedl S, Staimmer D, Hermanek P. Studiengruppe Kolorektales Karzinom (SGKRK) .
Langzeitergebnisse der chirurgischen Therapie des Coloncarcinoms.
Chirurg.
1994;
65
287-297
-
24
Jatzko G, Lisborg P, Wette V.
Improving survival rates for patients with colorectal cancer.
Br J Surg.
1992;
79
588-591
-
25
Jensen L S, Andersen A, Fristrup S C, Holme J B, Hvid H M, Kraglund K, Rasmussen P C, Toftgaard C.
Comparison of one dose versus three doses of prophylactic antibiotics, and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery.
Br J Surg.
1990;
77
513-518
-
26
Juul P, Klaaborg K E, Kronborg O.
Single or multiple doses of metronidazole and ampicillin in elective colorectal surgery.
Dis Colon Rectum.
1987;
30
526-528
-
27
Keller H W, Wolters U, Hülser R, Müller J M.
Die Entwicklung der kolorektalen Tumorchirurgie in den letzten 20 Jahren.
Zentralbl Chir.
1993;
118
122-126
-
28
Klein P, Allison D, Khuder S, Walsh A, Khan Z, Smith D, Webb T.
Long-term benefits of aggressive treatment for primary colorectal cancer.
J Surg Oncol.
1996;
62
258-266
-
29 Köckerling F, Gastinger I. Abdomino-perineale Rektumexstirpation mit hoher Durchtrennung der A. mesenterica inferior; Sigmaresektion. In: Kremer K, Lierse W, Platzer W, Schreiber HW, Weller S (Hrsg). Chirurgische Operationslehre. Thieme, Stuttgart, New York 1995; 267-291
-
30
Köckerling F, Hermanek P, Thom N, Gall F P.
Abdominale multiviszerale Resektion beim Kolonkarzinom.
Langenbecks Arch Chir Suppl (Kongreßber).
1992;
79-82
-
31
Köckerling F, Reymond M A, Altendorf-Hofmann A, Dworak O, Hohenberger W.
Influence of surgery on metachronous distant metastases and survival in rectal cancer.
J Clin Oncol.
1998;
16
324-329
-
32
Köckerling F, Reymond M A, Schneider C, Wittekind C, Scheid-bach H, Konradt J, Köhler L, Bärlehner E, Kuthe A, Bruch H P, Hohenberger W.. Laparoscopic Colorectal Surgery Study Group (LCSSG) .
Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer.
Dis Colon Rectum.
1998;
41
963-970
-
33
Köckerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond M A, Reck T, Konradt J, Bruch H P, Zornig C, Bärlehner E, Kuthe A, Szinicz G, Richter H A, Hohenberger W. Laparoscopic Colorectal Surgery Study Group (LCSSG) .
Laparoscopic colorectal anastomosis - risk of postoperative leakage: results of a multicenter study.
Surg Endosc.
1999;
13
639-644
-
34
Köckerling F, Schneider C, Reymond M A, Scheidbach H, Konradt J, Bärlehner E, Bruch H P, Kuthe A, Troidl H, Hohenberger W.. Laparoscopic Colorectal Surgery Study Group (LCSSG) .
Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery.
Surg Endosc.
1998;
12
37-41
-
35
Köckerling F, Schneider C, Reymond M A, Scheidbach H, Scheuerlein H, Konradt J, Bruch H P, Zornig C, Köhler L, Kuthe A, Szinicz G, Richter H A, Hohenberger W.. Laparoscopic Colorectal Surgery Study Group (LCSSG) .
Laparoscopic resection of sigmoid diverticulitis - results of a multicenter study.
Surg Endosc.
1999;
13
567-571
-
36
Konhäuser C, Altendorf-Hofmann A, Stolte M.
Operation technique determines frequency of recurrence of colorectal carcinoma.
Chirurg.
1999;
70
1042-1049
-
37
Kusche J, Stahlknecht C D.
Antibiotic prophylaxis in colorectal surgery: is there a drug of choise?.
Chirurg.
1981;
52
577-585
-
38
Lacy A M, Delgado S, Garcia-Valdecasas J C, Castells A, Piqué J M, Grande L, Fuster J, Targarona E M, Pera M, Visa J.
Port site metastases and recurrence after laparoscopic colectomy. A randomised trial.
Surg Endosc.
1998;
12
1039-1042
-
39
Lacy A M, Garcia-Valdecasas J C, Piqué J M, Delgado S, Campo E, Bordas J M, Taura P, Grande L, Fuster J, Visa J.
Short-term outcome analysis of a randomised study comparing laparoscopic vs open colectomy for colon cancer.
Surg Endosc.
1995;
9
1101-1105
-
40
Laurie J A, Moertel C G, Fleming T R, Wieand H S, Leigh J E, Rubin J, McCormack G W, Gerstner J B, Krook J E, Malliard J.
Surgical adjuvant therapy of large bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. The North Central Cancer Treatment Group and the Mayo Clinic.
J Clin Oncol.
1989;
7
1447-1456
-
41
Lehnert T, Herfarth C.
Grundlagen und Wert der Lymphadenektomie beim colorectalen Carcinom.
Chirurg.
1996;
67
889-899
-
42
Lehnert T, Herfarth C.
Multimodale Therapie des Coloncarcinoms.
Chirurg.
1998;
69
371-383
-
43 Leitlinien zur Therapie des Kolonkarzinoms. Beilage zu den Mitteilungen der Deutschen Gesellschaft für Chirurgie 1997; Heft 3
-
44
Lewi H JE, Carter D C, Ratcliffe J G, McArdle C S.
Second laparotomy following curative resection for colorectal cancer.
Ann R Coll Surg Engl.
1983;
65
314-315
-
45
Lippert H, Gastinger I.
Die chirurgische Qualitätssicherung am Beispiel der operativen Therapie des colorectalen Carcinoms.
Chirurg.
1995;
66
344-349
-
46
Lohr J, Wagner P K, Rothmund M.
Perioperative antibiotic prophylaxis (single or multiple dose) in elective colorectal surgery. A randomised study.
Chirurg.
1984;
55
512-514
-
47
MacRae H M, McLeod R S.
Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis.
Dis Colon Rectum.
1998;
41
180-189
-
48
Marusch F, Gastinger I, Schramm H, Lorenz D, Schönfelder M.
Chirurgische Qualitätssicherung am Beispiel der operativen Therapie des kolorektalen Karzinoms.
Zentralbl Chir.
2000;
125 (Suppl 2)
1-4
-
49
Michelassi F, Ayala J J, Balestracci T, Goldberg R, Chappell R, Block G E.
Verification of a new clinicopathological staging system for colorectal adenocarcinoma.
Ann Surg.
1991;
214
11-18
-
50
Miles W E.
A method of performing abdominoperineal excision for carcinoma of the rectum and terminal portion of the pelvic colon.
Lancet.
1908;
II
1812
-
51
Milsom J W, Böhm B, Hammerhofer K A, Fazio V, Steiger E, Elson P.
A prospective randomised trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery.
J Am Coll Surg.
1998;
187
46-55
-
52
Moertel C G, Fleming T R, McDonald J S, Haller D G, Laurie J A, Goodman P J, Ungerleider J S, Emerson W A, Tormey D C, Glick J H.
Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma.
N Engl J Med.
1992;
322
352-358
-
53
Moesgaard F, Lykkegaard-Nielsen M.
Preoperative cell-mediated immunity and duration of antibiotic prophylaxis in relation to postoperative infectious complications.
Acta Chir Scand.
1989;
155
281-286
-
54
Moynihan B G.
The surgical treatment of cancer of the sigmoid flexure and rectum: with special reference to the principles to be observed.
Surg Gynecol Obstet.
1908;
6
463
-
55
Müller J M.
Videoendoskopische Chirurgie. Eine Standortbestimmung.
Dtsch Ärztebl.
1999;
96
A1779
-
56
Olson R M, Perencevich N P, Malcom A W, Chaffey J T, Wilson R E.
Patterns of recurrence following curative resection of adenocarcinoma of the colon and rectum.
Cancer.
1980;
45
2969-2974
-
57
Pol B, Brandone J M, Le Treut Y P, Bricot R.
Excision of colorectal cancers: what can be expected of lymph node excision.
Ann Chir.
1989;
43
68-72
-
58
Rouffet F, Hay J M, Vacher B, Fingerhut A, Elhada A, Flamant Y, Mathon C, Gainant A.. French Association for Surgical Research .
Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy.
Dis Colon Rectum.
1994;
37
651-659
-
59 Schwenk W. Unterschiede im kurzfristigen Verlauf nach laparoskopischen und konventionellen Resektionen kolorektaler Tumoren. Habilitationsschrift, Medizinische Fakultät der Humboldt-Universität zu Berlin, Charité, Berlin, Germany 1997
-
60
Schwenk W, Hucke H P, Graupe F, Stock W.
Ist der Chirurg ein prognostisch relevanter Faktor nach R0-Resektion colorectaler Carcinome?.
Chirurg.
1995;
66
334-343
-
61
SCOTIA Study group .
Subtotal colectomy versus On-table irrigation and anastomosis. Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomised clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation.
Br J Surg.
1995;
82
1622-1627
-
62
Secco G B, Fardelli R, Rovida S, Ratto G B, Capponi G, Fabiano F, Motta G.
Colorectal cancer: prognosis after curative surgical treatment without extended elective lymphadenectomy in patients in Dukes C stage.
G Chir.
1989;
10
557-561
-
63
Silecchia G, Carlini M, Rosato P, De Leo A, Raparelli L.
Italian registry of laparoscopic colo-rectal surgery.
Surg Endosc.
1997;
11
534
-
64
Song F, Glenny A M.
Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials.
Br J Surg.
1998;
85
1232-1241
-
65
Stage J G, Schulze S, Moller P, Overgaard H, Andersen M, Rebsdorf-Pedersen V B, Nielsen H J.
Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma.
Br J Surg.
1997;
84
391-396
-
66
Sugarbaker P H, Corlew S.
Influence of surgical techniques on survival in patients with colorectal cancer.
Dis Colon Rectum.
1982;
25
545-557
-
67
Turnbull R B.
Cancer of the colon. The five- and ten-year survival rates following resection utilizing the isolation technique.
Ann R Coll Surg Engl.
1970;
46
243-250
-
68
Turnbull R B, Kyle K, Watson F R, Spratt J.
Cancer of the colon: the influence of the no-touch isolation technique on survival rates.
Ann Surg.
1967;
166
420-427
-
69
Turnbull R B, Kyle K, Watson F R, Spratt J.
Cancer of the colon: the influence of the no-touch isolation technique on survival rates.
CA Cancer J Clin.
1967;
18
82-87
-
70
Ulrich C.
24-hour systemic antibiotic prophylaxis in large-bowel surgery.
Neth J Surg.
1981;
33
3-9
-
71
Vukasin P, Orgea A E, Greene F L, Steele G D, Simons A J, Anthone G J, Weston L A, Beart R W.
Wound recurrence following laparoscopic colon cancer resection.
Dis Colon Rectum.
1996;
39 (Suppl 10)
S20
-
72
Wiggers T, Jeekel J, Arends J W, Brinkhorst A P, Kluck H M, Luyk C I, Munting J D, Povel J A, Rutten A P, Volovics A.
No-touch isolation technique in colon cancer: a controlled prospective trial.
Br J Surg.
1988;
75
409-415
-
73
Winker H, Dortenmann J, Wittmann D H.
Infection prevention in elective large intestine surgery.
Chirurg.
1983;
54
272-277
-
74 Wirsching R, Demmel N, Denecke H, Heberer G. Wandel und Fortschritte in der chirurgischen Behandlung des kolorektalen Karzinoms. Ergebnisse von 1 796 Patienten der Jahre 1973 bis 1984. Wissenschaftliche Ausstellung. 102. Kongreß der Deutschen Gesellschaft für Chirurgie 1985
-
75
Hewitt P M, Ip S M, Kwok S P, Somers S S, Li K, Leung K L, Lau W Y, Li A K.
Laparoscopic-assisted vs. open surgery for colorectal cancer comparative study of immune effects.
Dis Colon Rectum.
1998;
41
901-909
-
76
Kim S H, Milsom J W, Gramlich T L, Toddy S M, Shore G I, Okuda J, Fazio V W.
Does laparoscopic vs. conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection colorectal cancer?.
Dis Colon Rectum.
1998;
8
971-978
-
77
Leung K L, Lai P B, Ho R L, Meng W C, Yiu R Y, Lee J F, Lau W Y.
Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: A prospective randomized trial.
Ann Surg.
2000;
231
506-511
-
78
McCall J L, Parry B R.
Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma.
Br J Surg.
1997;
84
1174-1175
-
79
Schwenk W, Böhm B, Haase O, Junghans T, Müller J M.
Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding.
Langenbecks Arch Surg.
1998;
383
49-55
-
80
Schwenk W, Böhm B, Müller J M.
Postoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomize trial.
Surg Endosc.
1998;
12
1131-1136
-
81
Schwenk W, Böhm B, Witt C, Junghans T, Grundel K, Müller J M.
Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation.
Arch Surg.
1999;
134
6-12; discussion 13
-
82
Schwenk W, Mansmann U, Jacobi C, Böhm B, Müller J M.
Inflammatory response after laparoscopic and conventional colorectal resections - results of a prospective randomized trial.
Langenbecks Arch Surg.
2000;
385
2-9
Prof. Dr. I. Gastinger
Chirurgische Klinik
Carl-Thiem-Klinikum
Thiemstraße 111
D-03048 Cottbus
