Kelm M, Wiegering A, Germer C-T, Flemming S
Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
Chirurgie (Heidelb). 2023 May;94(5):412-416. doi: 10.1007/s00104-023-01823-y. Epub 2023 Mar 1.
Hereditary colorectal cancer (hCRC) represents a major diagnostic and therapeutic challenge. In addition to the usual diagnostic methods, the family history, histological confirmation and mutation analysis play an important role in identifying the type of hereditary CRC. The diagnosis and classification of hCRC are carried out based on the anamnesis, clinical presentation and histology and the further treatment is determined depending on the underlying type of hCRC. For familial adenomatous polyposis (FAP) coloproctomucosectomy after the end of puberty is always recommended, whereas the treatment recommendations for other forms, such as attenuated FAP (aFAP), MUTYH-associated polyposis (MAP) and hereditary nonpolyposis colon cancer (HNPCC, Lynch syndrome), range from close surveillance and endoscopic control, through segmental resection up to colectomy. Irrespective of the type of hCRC, the treatment regimens necessitate an individualized approach and require close interdisciplinary cooperation. When colorectal resection is performed, minimally invasive procedures should principally be prioritized and some studies could demonstrate a potential benefit of robotic surgery compared to laparoscopy.
遗传性结直肠癌(hCRC)是一个重大的诊断和治疗挑战。除了常规诊断方法外,家族史、组织学确诊和突变分析在确定遗传性结直肠癌的类型方面发挥着重要作用。hCRC的诊断和分类基于病史、临床表现和组织学,进一步的治疗则取决于hCRC的潜在类型。对于家族性腺瘤性息肉病(FAP),总是建议在青春期结束后进行结肠直肠黏膜切除术,而对于其他类型,如 attenuated FAP(aFAP)、MUTYH相关息肉病(MAP)和遗传性非息肉病性结直肠癌(HNPCC,林奇综合征),治疗建议范围从密切监测和内镜控制,到节段性切除直至结肠切除术。无论hCRC的类型如何,治疗方案都需要个体化方法,并需要密切的多学科合作。进行结直肠切除时,原则上应优先选择微创手术,一些研究表明与腹腔镜手术相比,机器人手术可能具有潜在优势。
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