Laparoskopische Therapie kolorektaler Karzinome: Bleiben Vorbehalte?

Zusammenfassung

Die Diskussion, ob kolorektale Karzinome laparoskopisch in kurativer Absicht reseziert werden dürfen, konzentriert sich auf die Frage nach der onkologischen Radikalität und Tumorzellverschleppung sowie die Problematik von Trokarkanalmetastasen. Im Hinblick auf bestehende Vorbehalte gegenüber der laparoskopischen Resektion muss überprüft werden, ob die laparoskopische Methode zu einer Qualitätsverbesserung in der Behandlung des kolorektalen Karzinoms führt, indem die kurz- und langfristigen Vorteile der laparoskopischen Therapie mit der konventionellen Chirurgie verglichen werden. Hierbei belegen randomisierte Studien (Phase IIIa), dass die kurzfristigen Resultate laparoskopischer Operationen zumindest gleichwertig sind, wobei onkologische Langzeitergebnisse noch ausstehen. Im Hinblick auf die Problematik von Trokarkanalmetastasen bestätigt sich, dass es sich hierbei um ein technisches Problem aus den Anfangsjahren laparoskopischer Tumorchirurgie handelt. Ob die laparoskopische Chirurgie des kolorektalen Karzinoms letztendlich zu identischen onkologischen Langzeitergebnissen führt wie die konventionelle Chirurgie, ist derzeit nicht vorbehaltlos zu beantworten, da die Resultate der multizentrischen randomisierten Studien (Phase IIIb) noch ausstehen.

Abstract

Controversial discussion focusses on the application of laparoscopic curative resection for colorectal cancer due to oncologic radicality, tumor cell dissemination, and port-site metastases. Considering the limitations of laparoscopic surgery, it is necessary to objectively evaluate whether laparoscopic surgery is associated with an improvement of quality related to curative treatment of colorectal cancer. Therefore, controlled studies comparing the results of laparoscopic vs. conventional cancer surgery are mandatory. To date, comparable short-term outcome of laparoscopic with open resection has been demonstrated by randomized studies (phase IIIa). However, long-term data including recurrence and survival are still missing. Focussing on the issue of port-site metastases, it has become obvious that the incidence of port-site metastases has been a technical problem of the initial phase of laparoscopic surgery for colorectal cancer. Finally, as randomized studies (phase IIIb) are still to be completed, the crucial issue whether laparoscopic resection for colorectal cancer is oncologically equivalent to open surgery cannot be answered definitely.

Schlüsselwörter

Laparoskopische Chirurgie - kolorektales Karzinom - Radikalität - Trokarkanalmetastasen

Key words

Laparoscopic surgery - colorectal cancer - radicality - port-site metastases

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