21
views
0
recommends
+1 Recommend
1 collections
    0
    shares

      Call for Papers: Current Management of Duodenal Neoplasia

      Submit here by March 31, 2025

      About Digestion: 3.0 Impact Factor I 7.9 CiteScore I 0.891 Scimago Journal & Country Rank (SJR)

      • Record: found
      • Abstract: found
      • Article: found

      Minimalinvasive Chirurgie bei Malignomen des Gastrointestinaltrakts: Kolon - Pro-Position

      review-article

      Read this article at

      ScienceOpenPublisher
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Hintergrund: Laparoskopische Resektionen von Kolonkarzinomen werden in Deutschland immer häufiger durchgeführt. Dabei müssen sich die minimalinvasiven Verfahren an den onkologischen Ergebnissen der offenen Chirurgie messen, die bisher den Goldstandard darstellen. Die vorliegende Arbeit soll anhand der evidenzbasierten Literatur einen kritischen Überblick über die Kurz- und Langzeitergebnisse der laparoskopischen Kolonchirurgie geben und sie in Bezug zu den Ergebnissen der offenen Chirurgie setzen. Methoden: Die Grundlage dieser Übersichtsarbeit bilden die fünf größten prospektiv randomisierten Studien zum Vergleich laparoskopischer und offener Chirurgie beim Kolonkarzinom (ALCCaS, Barcelona Trial, CLASICC Trial, COLOR Study und COST Study) sowie die bisher größte und aktuellste Metaanalyse. Im Folgenden sollen die erwähnten Studien hinsichtlich der Kurzzeit- und Langzeitergebnisse kritisch zusammengefasst sowie die wichtigsten Endpunkte beleuchtet werden. Ergebnisse: Die laparoskopische Chirurgie des Kolonkarzinoms ist hinsichtlich der onkologischen Langzeitergebnisse der offenen Resektion zumindest gleichwertig. Vorteile bestehen in der frühen postoperativen Phase sowie im perioperativen Outcome. Die höheren direkten Kosten werden durch kürzere Liegezeiten, niedrigere Morbidität und weniger Re-Interventionen bezüglich Adhäsionen und Narbenhernien ausgeglichen. Schlussfolgerungen: Eine kritische und individuelle Indikationsstellung vorausgesetzt, sollte bei entsprechender Expertise und Erfahrung den laparoskopischen Verfahren zur Therapie des Kolonkarzinoms der Vorzug gegeben werden, um den Patienten bei gleichwertigen onkologischen Langzeitergebnissen die Vorteile der minimalinvasiven Chirurgie nicht vorzuenthalten.

          Related collections

          Most cited references13

          • Record: found
          • Abstract: found
          • Article: not found

          Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.

          Laparoscopic-assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use. We compared short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer to predict long-term outcomes. Between July, 1996, and July, 2002, we undertook a multicentre, randomised clinical trial in 794 patients with colorectal cancer from 27 UK centres. Patients were allocated to receive laparoscopic-assisted (n=526) or open surgery (n=268). Primary short-term endpoints were positivity rates of circumferential and longitudinal resection margins, proportion of Dukes' C2 tumours, and in-hospital mortality. Analysis was by intention to treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN74883561. Six patients (two [open], four [laparoscopic]) had no surgery, and 23 had missing surgical data (nine, 14). 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively. 143 (29%) patients underwent conversion from laparoscopic to open surgery. Proportion of Dukes' C2 tumours did not differ between treatments (18 [7%] patients, open vs 34 [6%], laparoscopic; difference -0.3%, 95% CI -3.9 to 3.4%, p=0.89), and neither did in-hospital mortality (13 [5%] vs 21 [4%]; -0.9%, -3.9 to 2.2%, p=0.57). Apart from patients undergoing laparoscopic anterior resection for rectal cancer, rates of positive resection margins were similar between treatment groups. Patients with converted treatment had raised complication rates. Laparoscopic-assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to produce similar long-term outcomes. However, impaired short-term outcomes after laparoscopic-assisted anterior resection for cancer of the rectum do not yet justify its routine use.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial.

            Although early reports on laparoscopy-assisted colectomy (LAC) in patients with colon cancer suggested that it reduces perioperative morbidity, its influence on long-term results is unknown. Our study aimed to compare efficacy of LAC and open colectomy (OC) for treatment of non-metastatic colon cancer in terms of tumour recurrence and survival. From November, 1993, to July, 1998, all patients with adenocarcinoma of the colon were assessed for entry in this randomised trial. Adjuvant therapy and postoperative follow-up were the same in both groups. The main endpoint was cancer-related survival. Data were analysed according to the intention-to-treat principle. 219 patients took part in the study (111 LAC group, 108 OC group). Patients in the LAC group recovered faster than those in the OC group, with shorter peristalsis-detection (p=0.001) and oral-intake times (p=0.001), and shorter hospital stays (p=0.005). Morbidity was lower in the LAC group (p=0.001), although LAC did not influence perioperative mortality. Probability of cancer-related survival was higher in the LAC group (p=0.02). The Cox model showed that LAC was independently associated with reduced risk of tumour relapse (hazard ratio 0.39, 95% CI 0.19-0.82), death from any cause (0.48, 0.23-1.01), and death from a cancer-related cause (0.38, 0.16-0.91) compared with OC. This superiority of LAC was due to differences in patients with stage III tumours (p=0.04, p=0.02, and p=0.006, respectively). LAC is more effective than OC for treatment of colon cancer in terms of morbidity, hospital stay, tumour recurrence, and cancer-related survival.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial

              Summary Background Local recurrence rates in operable rectal cancer are improved by radiotherapy (with or without chemotherapy) and surgical techniques such as total mesorectal excision. However, the contributions of surgery and radiotherapy to outcomes are unclear. We assessed the effect of the involvement of the circumferential resection margin and the plane of surgery achieved. Methods In this prospective study, the plane of surgery achieved and the involvement of the circumferential resection margin were assessed by local pathologists, using a standard pathological protocol in 1156 patients with operable rectal cancer from the CR07 and NCIC-CTG CO16 trial, which compared short-course (5 days) preoperative radiotherapy and selective postoperative chemoradiotherapy, between March, 1998, and August, 2005. All analyses were by intention to treat. This trial is registered, number ISRCTN 28785842. Findings 128 patients (11%) had involvement of the circumferential resection margin, and the plane of surgery achieved was classified as good (mesorectal) in 604 (52%), intermediate (intramesorectal) in 398 (34%), and poor (muscularis propria plane) in 154 (13%). We found that both a negative circumferential resection margin and a superior plane of surgery achieved were associated with low local recurrence rates. Hazard ratio (HR) was 0·32 (95% CI 0·16–0·63, p=0·0011) with 3-year local recurrence rates of 6% (5–8%) and 17% (10–26%) for patients who were negative and positive for circumferential resection margin, respectively. For plane of surgery achieved, HRs for mesorectal and intramesorectal groups compared with the muscularis propria group were 0·32 (0·16–0·64) and 0·48 (0·25–0·93), respectively. At 3 years, the estimated local recurrence rates were 4% (3–6%) for mesorectal, 7% (5–11%) for intramesorectal, and 13% (8–21%) for muscularis propria groups. The benefit of short-course preoperative radiotherapy did not differ in the three plane of surgery groups (p=0·30 for trend). Patients in the short-course preoperative radiotherapy group who had a resection in the mesorectal plane had a 3-year local recurrence rate of only 1%. Interpretation In rectal cancer, the plane of surgery achieved is an important prognostic factor for local recurrence. Short-course preoperative radiotherapy reduced the rate of local recurrence for all three plane of surgery groups, almost abolishing local recurrence in short-course preoperative radiotherapy patients who had a resection in the mesorectal plane. The plane of surgery achieved should therefore be assessed and reported routinely. Funding Medical Research Council (UK) and the National Cancer Institute of Canada.
                Bookmark

                Author and article information

                Journal
                VIM
                VIS
                10.1159/issn.2297-4725
                Visceral Medicine
                S. Karger AG
                978-3-318-02363-3
                978-3-318-02364-0
                2297-4725
                2297-475X
                2013
                December 2013
                09 December 2013
                : 29
                : 6
                : 382-387
                Affiliations
                Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Deutschland
                Article
                356908 Viszeralmedizin 2013;29:382-387
                10.1159/000356908
                5294ccf7-da39-45bc-9e96-a1fb418f3817
                © 2014 S. Karger GmbH, Freiburg

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                Pages: 6
                Categories
                Übersichtsarbeit · Review Article

                Oncology & Radiotherapy,Gastroenterology & Hepatology,Surgery,Nutrition & Dietetics,Internal medicine
                Chirurgie, laparoskopische,Kolonkarzinom,Chirurgie, minimalinvasive

                Comments

                Comment on this article