Chirurgie des Rektumkarzinoms - Qualitätssicherung

Abstract

The successful treatment of locally advanced rectal cancer, classified as UICC stage II/III carcinoma in standardised staging procedures, depends fundamentally on the interdisciplinary cooperation of radiotherapists, surgeons, pathologists and oncologists. A number of studies during the last decade have revealed that the most limiting factor for a good prognosis for a given patient is his surgeon, i. e. his expertise in the field of colorectal surgery. Moreover does the course of disease of a patient significantly depend on the quality and diagnostic reliability of the pathologist in his histological evaluation of the resected specimen. This is particularly the case when the individual adjuvant therapy is based on the histo-pathological interpretation of the diagnostic findings. Not only the surgeon and the pathologist, but also the radiologist can be identified as “prognostic factor”, when local relapses occur prematurely. Multivariate analyses from the German rectal cancer study (CAO/ARO/AIO-94-trial) have shown that in addition to the sequence of therapy (preoperative or postoperative radiochemotherapy), the sex, or the institution in which the patient is treated, the radiotherapist himself is an independent factor in the avoidance of early local recurrences. The systemic treatment, domain of the oncologist, has as its principal task the reduction of systemic metastases. It is known meanwhile that irrespective of the individual therapy regimen, a delay in the onset of therapy or even the absence of therapy with the result of an inadequate dose application (cumulative total dose too little) is associated with an early relapse or systemic progress of the malignoma. Above all does the insufficient management of cytostatic drug-induced adverse effects negatively influence the patient compliance especially post surgery. It leads to discontinuation of treatment and to a negative cause of disease. In summary, only a close cooperation of the above mentioned disciplines guarantees the rectal cancer patient a maximum of therapeutic certitude and the prospect of cure. The individual, genetically determined longterm course of disease (still) cannot be influenced. But in addition to an optimization of quality control and an improvement in the quality of treatment, the implementation of accompanying translational research in present therapy trials is needed to improve the efficiency of the entire multimodal treatment.