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Rektumkarzinom

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Praxis der Viszeralchirurgie Onkologische Chirurgie

Zusammenfassung

Das Rektumkarzinom verhält sich aufgrund seiner lymphatischen Ausbreitungswege anders als das Kolonkarzinom und hat insbesondere ein höheres lokoregionäres Rezidivrisiko. Trotz vieler technischer Variationen ist die En-bloc-Resektion des Tumors einschließlich der regionalen Gefäßversorgung unverändert der zentrale Eckpfeiler der chirurgischen Therapie. Systematische pathoanatomische Erkenntnisse zur perirektalen Tumorausbreitung, ein besseres Verständnis der Kontinenzmechanismen und ein optimiertes Instrumentarium führten dazu, dass ca. 85% der Rektumkarzinome kontinenzerhaltend operiert werden können. Bei Tumoren des oberen Rektumdrittels stellt das kein Problem dar, die Rekonstruktion erfolgt durch eine End-zu-End-Deszendorektostomie. Bei Tumoren des mittleren und distalen Rektumdrittels ist die totale mesorektale Exzision obligat. Hier stellt die Kolonpouch-anale Anastomose mit vorgeschaltetem Kolon-J-Reservoir die derzeitige Standardrekonstruktion dar. Die lokale Exzision (endoskopisch oder chirurgisch transanal) beschränkt sich auf uT1-Low-risk-Tumoren. Neoadjuvante Therapieansätze haben einen festen Stellenwert bei extraperitoneal gelegenen wandüberschreitenden oder nodalpositiven Tumoren.

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Authors and Affiliations

  1. Chirurgische Klinik A, Allgemein-, Viszeral-, Thorax- und Unfallchirurgie, Klinikum der Stadt Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen

    Prof. Dr. med. S. Willis

  2. Chirurgische Klinik und Poliklinik, Medizinische Fakultät der RWTH, Pauwelstraße 30, 52057, Aachen

    Univ.-Prof. Dr. med. V. Schumpelick

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  1. Prof. Dr. med. S. Willis
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  2. Univ.-Prof. Dr. med. V. Schumpelick
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Editors and Affiliations

  1. Universitätsklinikum Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg

    J. R. Siewert (Leitender Ärztlicher Direktor und Vorstandsvorsitzender) (Leitender Ärztlicher Direktor und Vorstandsvorsitzender)

  2. Zentrum für Operative Medizin I, Klinikum der Philipps-Universität, Baldinger Straße, 35043, Marburg

    Matthias Rothmund

  3. Universitätsklinik und Poliklinik, Medizinische Fakultät der RWTH, Pauwelsstraße 30, 52057, Aachen

    Volker Schumpelick

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Willis, S., Schumpelick, V. (2010). Rektumkarzinom. In: Siewert, J.R., Rothmund, M., Schumpelick, V. (eds) Praxis der Viszeralchirurgie Onkologische Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03808-2_48

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  • DOI: https://doi.org/10.1007/978-3-642-03808-2_48

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