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Lebensqualität nach Rektumkarzinomoperation

Quality of life after rectal cancer surgery

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Zusammenfassung

Die multimodale Therapie des fortgeschrittenen Rektumkarzinoms beeinhaltet eine optimierte Chirurgie mit totaler mesorektaler Exzision, eine (neo-/adjuvante) Radiochemotherapie und/oder eine systemische Chemotherapie. Dabei ist die integrale Betrachtung von Lebensverlängerung und Lebensqualität (LQ) noch viel zu selten Grundlage der Therapieentscheidung. Ziel der vorliegenden Übersichtsarbeit ist es, verschiedene Aspekte der LQ-Bestimmung bei der chirurgischen Therapie darzustellen. Generell ist die permanente Kolostomie im Gegensatz zur anterioren Rektumresektion nicht zwangsläufig mit einer schlechten postoperativen LQ assoziiert. Die Rückverlegung einer protektiven Ileostomie erhöht bei Patienten mit Rektumkarzinom die LQ. Die laparoskopische totale mesorektale Exzision bietet in Bezug auf die LQ derzeit keine messbaren Vorteile im Vergleich zur konventionell offenen Operation. Wenn technisch möglich, bietet die Kolon-J-Pouch-Rekonstruktion messbare Vorteile der postoperativen LQ gegenüber Rekonstruktionsformen wie der geraden Anastomose und/oder der Koloplastie. Die Kenntnis der postoperativen Einschränkungen der LQ und eine konsequente präoperative Aufklärung helfen, die postoperative LQ der betroffenen Patienten zu verbessern.

Abstract

Multimodal treatment of advanced rectal cancer involves excision of the rectum in conjunction with pelvic radiotherapy and chemotherapy. Outcome assessment in oncologic surgery for rectal cancer has conventionally included data regarding perioperative mortality and morbidity, disease recurrence, and long-term survival. Throughout the past decade however research has increased in the field of patient-reported outcome, and quality of life (QoL) is now regarded as a key measurement in assessing outcomes of interventions. The aim of this review paper was to evaluate QoL assessment in different aspects of rectal surgery. In general patients undergoing abdominoperineal excision with permanent colostomy did not have poorer QoL measures than those undergoing anterior resection. Reversal of a dysfunctional loop ileostomy in surgery for low rectal cancer improves most patients’ overall QoL. The previously reported short- and long-term QoL analysis of laparoscopic vs conventional open rectal surgery revealed no significant differences. In patients undergoing restorative resection for low rectal cancer, colonic J pouches offer significant advantages in function and QoL over straight anastomosis or coloplasty.

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  1. Klinik und Poliklinik für Allgemein- und Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Zentrum Operative Medizin (ZOM), Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland

    C.-T. Germer & C. Isbert

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  1. C.-T. Germer
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  2. C. Isbert
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Correspondence to C.-T. Germer.

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Germer, CT., Isbert, C. Lebensqualität nach Rektumkarzinomoperation. Chirurg 80, 316–323 (2009). https://doi.org/10.1007/s00104-008-1623-6

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