Evidence-based Chirurgie desKolonkarzinoms

Abstract

Only a few therapeutic approaches in colon cancer therapy are based on controlled study results. Via an internet search using different search strategies 965 abstracts written about colon cancer therapy between 1980-2000 were analysed. Studies focussing on adjuvant therapy were not included. We found 446 retrospective, 150 prospective randomized, 151 prospective non-randomized studies and 218 review articles. Controlled study results as a scientific base are available for perioperative antibiotic prophylaxis (127 prospective randomized studies), mechanical intestinal cleansing (n = 5), a similar efficacy of stapler and hand-made anastomosis (n = 15), and the early onset of a stage-adjusted nutrition (n = 3). Our internet search shows that only a minor fraction (approximately 10%) of colon surgery is evidence based. The most important prerequisites for an appropriate surgical resection are the pathology results reflecting the degree of tumor spreading. Besides the data from controlled studies we have to take the results from prospective multi-center studies in consideration.

Emergency operation in carcinomas of the left colon: value of Hartmann?s procedure

“…Results obtained in prospective, multicentre observational studies are important to investigate specific aspects of the surgical technique and tactic [2][3][4].…”

Stellenwert der laparoskopischen Chirurgie des Kolonkarzinoms in der klinischen Routine

“…Das Verfahren ist bis jetzt kein endgültig evaluiertes Standardverfahren in der Behandlung des Kolonkarzinoms [7,9,11,21]. Es liegt daher nahe, die Ergebnisqualität der laparoskopischen Technik in der Breite mehrer Anwender zu untersuchen.…”

Low-volume centre vs high-volume: the role of a quality assurance programme in colon cancer surgery

“…Surgical oncology requires an ongoing approach to the question of quality, reflecting the current development of the multimodal therapeutic regimes. Although colon cancer is one of the most common malignancies, there is limited evidence to support different surgical options [1]. There is a bidirectional influence of quality control, on the one hand defining whether the treatment is conducted in accordance with the guidelines and on the other whether the results of standardized treatment influence changes within the guidelines [2].…”