Skip to main content
Erschienen in: Der Gastroenterologe 1/2016

01.02.2016 | Kolorektales Karzinom | CME

Interdisziplinäre Therapie des Rektumkarzinoms

verfasst von: C. Rimkus, H. Seidl, W. Heiland, PD Dr. F. G. Bader

Erschienen in: Die Gastroenterologie | Ausgabe 1/2016

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das Adenokarzinom des Rektums stellt das interdisziplinäre Behandlungsteam vor diagnostische und therapeutische Herausforderungen. Die multimodale Therapie steht dabei im Mittelpunkt, denn gerade durch ihren zunehmenden Einsatz bei lokal fortgeschrittenen Tumoren konnte die Effektivität der onkologischen Therapie gesteigert werden. Die Therapieentscheidung wird anhand des Tumorstadiums sowie der Tumorlokalisation getroffen. Zusätzliche Risikofaktoren werden im Rahmen des primären Tumorstagings identifiziert, um das entsprechende Therapieregime darauf abzustimmen. Aus diesem Grund kommt dem primären Tumorstaging die zentrale Bedeutung zu. Darüber hinaus führt die detaillierte Darstellbarkeit der anatomischen präoperativen Verhältnisse zu einer verbesserten Planung des therapeutischen Vorgehens bei Tumoren im Bereich des Sphinkterapparats und dadurch zu einer Steigerung kontinenzerhaltender Operationen. Mit der totalen mesorektalen Exzision (TME) hat sich ein operativer Qualitätsstandard etabliert, der das Langzeitergebnis der Patienten entscheidend beeinflusst. Zunehmende Akzeptanz findet in diesem Zusammenhang der Einsatz minimalinvasiver Techniken. (Neo)adjuvante Therapiekonzepte befinden sich weiterhin in Validierung, um insgesamt die Effektivität der onkologischen Therapie des Rektumkarzinoms zu verbessern.
Literatur
1.
Zurück zum Zitat Stelzner F (2006) Zellvermehrungsselbstkontrolle der polypösen Adenome und Karzinogenese in der Kolorektalregion. Chirurg 11:1048–1055CrossRef Stelzner F (2006) Zellvermehrungsselbstkontrolle der polypösen Adenome und Karzinogenese in der Kolorektalregion. Chirurg 11:1048–1055CrossRef
2.
Zurück zum Zitat Stelzner F, Friedrichs N, von Mallek (2009) Hüllfaszien, Homingareal und Lymphgefäße sind krebsarretierend. Chirurg 80(3):216–222CrossRef Stelzner F, Friedrichs N, von Mallek (2009) Hüllfaszien, Homingareal und Lymphgefäße sind krebsarretierend. Chirurg 80(3):216–222CrossRef
3.
Zurück zum Zitat Levy M, Visokai V, Lipska L et al (2008) Tumor markers in staging and prognosis of colorectal carcinoma. Neoplasma 55(2):138–142PubMed Levy M, Visokai V, Lipska L et al (2008) Tumor markers in staging and prognosis of colorectal carcinoma. Neoplasma 55(2):138–142PubMed
4.
Zurück zum Zitat Bipat S, Glas A, Slors F et al (2004) Rectal cancer: local staging and assessment of lymph node involvement with Endoluminal US, CT, and MR imaging – a meta-analysis. Radiology 232(3):773–783CrossRefPubMed Bipat S, Glas A, Slors F et al (2004) Rectal cancer: local staging and assessment of lymph node involvement with Endoluminal US, CT, and MR imaging – a meta-analysis. Radiology 232(3):773–783CrossRefPubMed
5.
Zurück zum Zitat MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333(7572):779PubMedCentralCrossRef MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333(7572):779PubMedCentralCrossRef
6.
Zurück zum Zitat Nagategaal JD, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312CrossRef Nagategaal JD, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312CrossRef
7.
Zurück zum Zitat Smith NJ, Barbachano Y, Norman AR et al (2008) Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 95:229–236CrossRefPubMed Smith NJ, Barbachano Y, Norman AR et al (2008) Prognostic significance of magnetic resonance imaging-detected extramural vascular invasion in rectal cancer. Br J Surg 95:229–236CrossRefPubMed
8.
Zurück zum Zitat Rödel C, Liersch T, Becker H et al (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet 13(7):679–687CrossRefPubMed Rödel C, Liersch T, Becker H et al (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet 13(7):679–687CrossRefPubMed
9.
Zurück zum Zitat Rödel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23(34):8688–8696CrossRefPubMed Rödel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23(34):8688–8696CrossRefPubMed
10.
11.
Zurück zum Zitat Guillem JG, Díaz-González J, Minsky BD et al (2008) cT3N0 rectal cancer: potential Overtreatment with preoperative Chemoradiotherapy is warranted. JCO 26(3):368–373CrossRef Guillem JG, Díaz-González J, Minsky BD et al (2008) cT3N0 rectal cancer: potential Overtreatment with preoperative Chemoradiotherapy is warranted. JCO 26(3):368–373CrossRef
12.
Zurück zum Zitat Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355(11):1114–1123CrossRefPubMed Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355(11):1114–1123CrossRefPubMed
13.
Zurück zum Zitat Kauer WK, Prantl L, Dittler HJ et al (2004) The value of endosonographic rectal carcinoma staging in routine diagnostics: a 10-year analysis. Surg Endosc 18(7):1075–1078CrossRefPubMed Kauer WK, Prantl L, Dittler HJ et al (2004) The value of endosonographic rectal carcinoma staging in routine diagnostics: a 10-year analysis. Surg Endosc 18(7):1075–1078CrossRefPubMed
14.
Zurück zum Zitat Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23(24):5644–5650CrossRefPubMed Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23(24):5644–5650CrossRefPubMed
15.
Zurück zum Zitat Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987CrossRef Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987CrossRef
16.
Zurück zum Zitat Pettersson D, Cedermark B, Holm T et al (2010) Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 97(4):580–587CrossRefPubMed Pettersson D, Cedermark B, Holm T et al (2010) Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 97(4):580–587CrossRefPubMed
17.
Zurück zum Zitat Pettersson D, Holm T, Iversen H et al (2012) Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg 99(4):577–583CrossRefPubMed Pettersson D, Holm T, Iversen H et al (2012) Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg 99(4):577–583CrossRefPubMed
18.
Zurück zum Zitat Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701CrossRefPubMed Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701CrossRefPubMed
19.
Zurück zum Zitat Van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582CrossRefPubMed Van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582CrossRefPubMed
20.
Zurück zum Zitat Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820PubMedCentralCrossRefPubMed Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820PubMedCentralCrossRefPubMed
21.
Zurück zum Zitat Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–T4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625CrossRefPubMed Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–T4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625CrossRefPubMed
22.
Zurück zum Zitat Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740CrossRefPubMed Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740CrossRefPubMed
23.
Zurück zum Zitat Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27(31):5124–5130PubMedCentralCrossRefPubMed Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27(31):5124–5130PubMedCentralCrossRefPubMed
24.
Zurück zum Zitat Hofheinz RD, Wenz F, Post S et al (2012) Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 13(6):579–588CrossRefPubMed Hofheinz RD, Wenz F, Post S et al (2012) Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol 13(6):579–588CrossRefPubMed
25.
Zurück zum Zitat Aschele C, Cionini L, Lonardi S et al (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 29(20):2773–2780CrossRefPubMed Aschele C, Cionini L, Lonardi S et al (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 29(20):2773–2780CrossRefPubMed
26.
Zurück zum Zitat Pettersson D, Glimelius B, Iversen H et al (2013) Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III Trial. Br J Surg 100(7):969–975CrossRefPubMed Pettersson D, Glimelius B, Iversen H et al (2013) Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III Trial. Br J Surg 100(7):969–975CrossRefPubMed
27.
Zurück zum Zitat Veenhof AA, Bloemena E, Engel AF et al (2009) The relationship of histological tumor regression grade (TRG) and two different time intervals to surgery following radiation therapy for locally advanced rectal cancer. Int J Colorectal Dis 24(9):1091–1096CrossRefPubMed Veenhof AA, Bloemena E, Engel AF et al (2009) The relationship of histological tumor regression grade (TRG) and two different time intervals to surgery following radiation therapy for locally advanced rectal cancer. Int J Colorectal Dis 24(9):1091–1096CrossRefPubMed
28.
Zurück zum Zitat Cummings BJ, Rider WD, Harwood AR (1983) Radical external beam radiation therapy for adenocarcinoma of the rectum. Dis Colon Rectum 26:30–36CrossRefPubMed Cummings BJ, Rider WD, Harwood AR (1983) Radical external beam radiation therapy for adenocarcinoma of the rectum. Dis Colon Rectum 26:30–36CrossRefPubMed
29.
Zurück zum Zitat Graf W, Dahlberg M, Mazloum-Osman M et al (1997) Short-term preoperative radiotherapy results in down staging of rectal cancer: a study of 1316 patients. Radiother Oncol 43:133–137CrossRefPubMed Graf W, Dahlberg M, Mazloum-Osman M et al (1997) Short-term preoperative radiotherapy results in down staging of rectal cancer: a study of 1316 patients. Radiother Oncol 43:133–137CrossRefPubMed
30.
Zurück zum Zitat Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939CrossRefPubMed Sloothaak DA, Geijsen DE, van Leersum NJ et al (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939CrossRefPubMed
31.
Zurück zum Zitat Petrelli F, Sgroi G, Sarti E et al (2013) Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: A meta-analysis of published studies. Ann Surg Petrelli F, Sgroi G, Sarti E et al (2013) Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: A meta-analysis of published studies. Ann Surg
32.
Zurück zum Zitat Bengt G (2014) Optimal time intervals between pre-operative radiotherapy or chemoradiotherapy and surgery in rectal cancer? Front Oncol 4:50 Bengt G (2014) Optimal time intervals between pre-operative radiotherapy or chemoradiotherapy and surgery in rectal cancer? Front Oncol 4:50
33.
Zurück zum Zitat Stein DE, Mahmoud NN, Anne PR et al (2003) Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum 46(4):448–453CrossRefPubMed Stein DE, Mahmoud NN, Anne PR et al (2003) Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum 46(4):448–453CrossRefPubMed
34.
Zurück zum Zitat Lim SB, Choi HS, Jeong SY et al (2008) Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg 248(2):243–251CrossRefPubMed Lim SB, Choi HS, Jeong SY et al (2008) Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg 248(2):243–251CrossRefPubMed
35.
Zurück zum Zitat Francois Y, Nemoz CJ, Baulieux J et al (1999) Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 17(8):2396–2402PubMed Francois Y, Nemoz CJ, Baulieux J et al (1999) Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 17(8):2396–2402PubMed
36.
Zurück zum Zitat Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P et al (2003) A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 46(3):298–304CrossRefPubMed Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P et al (2003) A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 46(3):298–304CrossRefPubMed
37.
Zurück zum Zitat Vecchio FM, Valentini V, Minsky BD et al (2005) The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 62(3):752–760CrossRefPubMed Vecchio FM, Valentini V, Minsky BD et al (2005) The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 62(3):752–760CrossRefPubMed
38.
Zurück zum Zitat Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11(9):835–844CrossRefPubMed Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11(9):835–844CrossRefPubMed
39.
Zurück zum Zitat Hartley A, Giridharan S, Gray L et al (2002) Retrospective study of acute toxicity following short-course preoperative radiotherapy. Br J Surg 89(7):889–895CrossRefPubMed Hartley A, Giridharan S, Gray L et al (2002) Retrospective study of acute toxicity following short-course preoperative radiotherapy. Br J Surg 89(7):889–895CrossRefPubMed
40.
Zurück zum Zitat Fokstuen T, Holm T, Glimelius B (2009) Postoperative morbidity and mortality in relation to leukocyte counts and time to surgery after short-course preoperative radiotherapy for rectal cancer. Radiother Oncol 93(2):293–297CrossRefPubMed Fokstuen T, Holm T, Glimelius B (2009) Postoperative morbidity and mortality in relation to leukocyte counts and time to surgery after short-course preoperative radiotherapy for rectal cancer. Radiother Oncol 93(2):293–297CrossRefPubMed
41.
Zurück zum Zitat Jakobsen A, Ploen J, Vuong T et al (2012) Dose-effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int J Radiat Oncol Biol Phys 84(4):949–954CrossRefPubMed Jakobsen A, Ploen J, Vuong T et al (2012) Dose-effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int J Radiat Oncol Biol Phys 84(4):949–954CrossRefPubMed
42.
Zurück zum Zitat Ueno H, Mochizuki H, Hashiguchi Y et al (2004) Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 127(2):385–394CrossRefPubMed Ueno H, Mochizuki H, Hashiguchi Y et al (2004) Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 127(2):385–394CrossRefPubMed
43.
Zurück zum Zitat Participants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 58(6 Suppl):3–43 Participants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc 58(6 Suppl):3–43
44.
Zurück zum Zitat Nascimbeni R, Burgart LJ, Nivatvongs S et al (2002) Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45(2):200–206CrossRefPubMed Nascimbeni R, Burgart LJ, Nivatvongs S et al (2002) Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45(2):200–206CrossRefPubMed
45.
Zurück zum Zitat Carrara A, Mangiola D, Pertile R et al (2012) Analysis of Risk Factors for Lymph Nodal Involvement in Early Stages of Rectal Cancer: When Can Local Excision Be Considered an Appropriate Treatment? Systematic Review and Meta-Analysis of the Literature. Int J Surg Oncol 2012:Article ID 438450 doi:10.1155/2012/438450 Carrara A, Mangiola D, Pertile R et al (2012) Analysis of Risk Factors for Lymph Nodal Involvement in Early Stages of Rectal Cancer: When Can Local Excision Be Considered an Appropriate Treatment? Systematic Review and Meta-Analysis of the Literature. Int J Surg Oncol 2012:Article ID 438450 doi:10.1155/2012/438450
46.
Zurück zum Zitat Tanaka S, Kashida H, Saito Y et al (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 27(4):417–434CrossRefPubMed Tanaka S, Kashida H, Saito Y et al (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 27(4):417–434CrossRefPubMed
47.
Zurück zum Zitat Fazio VW, Zutshi M, Remzi FH et al (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246(3):481–488PubMedCentralCrossRefPubMed Fazio VW, Zutshi M, Remzi FH et al (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246(3):481–488PubMedCentralCrossRefPubMed
48.
Zurück zum Zitat Liao C, Gao F, Cao Y (2010) Meta-analysis of the colon J-Pouch vs transverse coloplasty pouch after anterior resection for rectal cancer. Colorectal Dis 12(7):624–631CrossRefPubMed Liao C, Gao F, Cao Y (2010) Meta-analysis of the colon J-Pouch vs transverse coloplasty pouch after anterior resection for rectal cancer. Colorectal Dis 12(7):624–631CrossRefPubMed
49.
Zurück zum Zitat Vennix S, Pelzers L, Bouvy N et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200PubMed Vennix S, Pelzers L, Bouvy N et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200PubMed
50.
Zurück zum Zitat Späth C, Müller T, Nitsche U et al (2013) Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltraktes: Kolon-Pro-Position. Viszeralmedizin 29:382–387 Späth C, Müller T, Nitsche U et al (2013) Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltraktes: Kolon-Pro-Position. Viszeralmedizin 29:382–387
51.
Zurück zum Zitat Martin ST, Heneghan HM, Winter DC (2012) Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 99(7):918–928CrossRefPubMed Martin ST, Heneghan HM, Winter DC (2012) Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg 99(7):918–928CrossRefPubMed
52.
Zurück zum Zitat Perez RO, Habr-Gama A, Sao Juliao GP et al (2012) Optimal timing for assessment of tumor response to neoadjuvant chemoradiation in patients with rectal cancer: do all patients benefit from waiting longer than 6 weeks? Int J Radiat Oncol Biol Phys 84(5):1159–1165CrossRefPubMed Perez RO, Habr-Gama A, Sao Juliao GP et al (2012) Optimal timing for assessment of tumor response to neoadjuvant chemoradiation in patients with rectal cancer: do all patients benefit from waiting longer than 6 weeks? Int J Radiat Oncol Biol Phys 84(5):1159–1165CrossRefPubMed
53.
Zurück zum Zitat Sprawka A, Pietrzak L, Garmol D et al (2023) Definitive radical external beam radiotherapy for rectal cancer: evaluation of local effectiveness and risk of late small bowel damage. Acta Oncol 52(4):816–823CrossRef Sprawka A, Pietrzak L, Garmol D et al (2023) Definitive radical external beam radiotherapy for rectal cancer: evaluation of local effectiveness and risk of late small bowel damage. Acta Oncol 52(4):816–823CrossRef
Metadaten
Titel
Interdisziplinäre Therapie des Rektumkarzinoms
verfasst von
C. Rimkus
H. Seidl
W. Heiland
PD Dr. F. G. Bader
Publikationsdatum
01.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Gastroenterologie / Ausgabe 1/2016
Print ISSN: 2731-7420
Elektronische ISSN: 2731-7439
DOI
https://doi.org/10.1007/s11377-015-0031-y

Weitere Artikel der Ausgabe 1/2016

Der Gastroenterologe 1/2016 Zur Ausgabe

Mitteilungen des BDI

Mitteilungen des BDI

Mitteilungen der Stiftung LebensBlicke

Mitteilungen der Stiftung LebensBlicke

Schwerpunkt: Komplikationen der Leberzirrhose

Aszites und seine Komplikationen

Berufspolitisches Forum

Korruption im Gesundheitswesen

Schwerpunkt: Komplikationen der Leberzirrhose

Leberzirrhose

Schwerpunkt: Komplikationen der Leberzirrhose

Hepatische Enzephalopathie