Rektumkarzinomchirurgie in Deutschland – eine 10-Jahres-Übersicht auf der Grundlage der Daten des AN-Instituts für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke-Universität Magdeburg^[*]

 

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Zusammenfassung

Hintergrund: Die Behandlung des Rektumkarzinoms hat sich in den letzten 2 Dekaden deutlich gewandelt. Durch konsequenten Einsatz neoadjuvanter Therapieverfahren und Anwendung der totalen mesorektalen Exzision beim tief sitzenden Rektumkarzinom konnte die lokale Tumorkontrolle signifikant gebessert werden. Mit der vorliegenden Analyse sollen die Umsetzung der multimodalen Therapie beim Rektumkarzinom unter den Bedingungen der Routineversorgung sowie die erreichten Ergebnisse über einen 10-Jahres-Zeitraum untersucht werden. Methode: Es wurden die Daten der prospektiven multizentrischen Beobachtungsstudie „Qualitätssicherung – Rektumkarzinom“ der Jahre 2000 bis 2010 ausgewertet. N = 33  724 Patienten wurden erfasst. Die Resektionsrate betrug 95,2 %. Die Rate kurativer Resektionen betrug 84,2 %. Ergebnisse: Die postoperative Gesamtmorbidität und Letalität zeigten keine Änderung im Verlauf der Beobachtung. Der Anteil neoadjuvant behandelter Patienten mit kurativer Resektion stieg von 5,6 % (2000) auf 40,5 % (2010). Die TME-Rate stieg bei tiefsitzenden Karzinomen von 75,2 % (2000) auf 95,3 % (2010). Für Patienten, die in den Jahren 2000/2001 kurativ reseziert wurden, lag die 5-Jahres-Lokalrezidivrate bei 11,7 %, während diese für in den Jahren 2005/2006 resezierte Patienten bei 4,6 % lag (p < 0,001). Eine Verbesserung des Gesamtüberlebens zeigte sich nicht. Schlussfolgerung: Bei gleichbleibender Gesamtmorbidität und Letalität hat der zunehmende Einsatz neoadjuvanter Behandlungen und die Etablierung der TME in der flächendeckenden Routineversorgung von Patienten mit Rektumkarzinomen zu einer signifikanten Verbesserung der lokalen Tumorkontrolle geführt, ohne dass ein Einfluss auf das Gesamtüberleben der Patienten nachweisbar ist.

Abstract

Background: The treatment of rectal cancer has undergone pronounced changes during the last two decades. There has been a significant improvement in local tumour control due to consequent use of neo-adjuvant therapy and total mesorectal excision in cases of distal rectal cancer. The presented analysis examines the realisation of the multimodal therapy for rectal cancer under the conditions of routine patient-centred care over a period of ten years. Method: The data acquired in the prospective multicentre observational study “Quality Assurance – Rectal Cancer” from the years 2000 to 2010 were analysed. N = 33,724 patients were documented. The resection rate was 95.2 %. The rate of curative resection was 84.2 %. Results: No change was detected in perioperative total morbidity and lethality during the course of the study. The percentage of patients with neo-adjuvant treatment and curative resection rose from 5.6 % (2000) to 40.5 % (2012). The rate of performed TME in distal rectal cancer rose from 75.2 % (2000) to 95.3 % (2012). For patients who underwent curative resection in the years 2000/2001 the 5-year local recurrence rate was 11.7 %, while it was found to be 4.6 % for patients who were thus treated in the years 2005/2006 (p < 0.001). There was no improvement of total survival. Conclusion: While an increase in the use of neo-adjuvant treatment for rectal cancer and the establishment of TME in routine patient-centred care have led to a significant improvement in local tumour control with a constant total morbidity and lethality, there is no detectable influence on the patientsʼ total survival.

^* Prof. Dr. Dr. H. Lippert gewidmet

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