{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T06:28:38Z","timestamp":1746772118158},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Hintergrund Das chirurgische Vorgehen beim kolorektalen Karzinom (KRK) in der Palliativsituation l\u00e4sst sich nur unzureichend standardisieren. Die vorliegende Studie wurde zur Identifikation von Kriterien f\u00fcr den Entscheid hinsichtlich Resektion des Malignoms mit oder ohne prim\u00e4re Anastomose initiiert.<\/jats:p><jats:p>Patienten\/Material und Methoden In einer unizentrischen retrospektiven Analyse wurden 103 Patienten nach palliativer Resektion eines KRK mit oder ohne zeitgleiche Anastomose untersucht. Durch univariate und logistische Regressionsanalyse erfolgte die Beurteilung des Einflusses von insgesamt 40 Faktoren auf die postoperative Morbidit\u00e4t und Mortalit\u00e4t.<\/jats:p><jats:p>Ergebnisse In 46 F\u00e4llen wurde eine Darmresektion mit prim\u00e4rer Anastomose, in 57 F\u00e4llen eine Diskontinuit\u00e4tsresektion durchgef\u00fchrt. Die postoperative Morbidit\u00e4t betrug insgesamt 44,7%, die Letalit\u00e4t 17,5%. Nach einzeitiger Resektion und Anastomose erh\u00f6hte ein Nikotinabusus (OR 4,2; p\u2009=\u20090,044), eine Hypalbumin\u00e4mie (OR 4,0; p\u2009=\u20090,012), eine Kachexie (OR 3,9; p\u2009=\u20090,034), ein ASA-Score &gt;\u20092 (OR 3,7; p\u2009=\u20090,030) und ein(e) Leberumbau\/-zirrhose (OR 3,6; p\u2009=\u20090,031) das Risiko f\u00fcr postoperative Komplikationen. Die Hypalbumin\u00e4mie (OR 1,8; p\u2009=\u20090,036), Kachexie (OR 1,8; p\u2009=\u20090,043), An\u00e4mie (OR 1,5; p\u2009=\u20090,038) und ein bekannter Alkoholabusus (OR 1,9; p\u2009=\u20090,023) wurden als unabh\u00e4ngige Risikofaktoren f\u00fcr die fr\u00fchpostoperative Mortalit\u00e4t identifiziert. Nach Diskontinuit\u00e4tsresektion f\u00fchrten eine Niereninsuffizienz (OR 2,1; p\u2009=\u20090,042) und Kachexie (OR 1,5; p\u2009=\u20090,045) zum signifikanten Anstieg des Risikos f\u00fcr die postoperative Morbidit\u00e4t, ein Alkoholabusus (OR 1,8; p\u2009=\u20090,041) f\u00fcr die Letalit\u00e4t. Eine Hypalbumin\u00e4mie (OR 2,8; p\u2009=\u20090,019) und ein ASA-Score &gt;\u20092 (OR 2,6; p\u2009=\u20090,004) steigerten nach Resektion und Rekonstruktion das Risiko f\u00fcr Majorkomplikationen entsprechend Clavien-Dindo, eine vorbestehende Niereninsuffizienz (OR 1,6; p\u2009=\u20090,023) das Risiko nach Diskontinuit\u00e4tsresektion. In der univariaten Analyse wurden nach Tumorresektion und Rekonstruktion zus\u00e4tzlich noch ein ASA-Score &gt;\u20092 (p\u2009=\u20090,038), in beiden Gruppen mit und ohne prim\u00e4re Anastomose eine dringliche Operation als signifikante Parameter mit Einfluss auf die Letalit\u00e4t ermittelt (p\u2009=\u20090,010 und p\u2009=\u20090,017).<\/jats:p><jats:p>Schlussfolgerung Palliative Resektionen kolorektaler Karzinome haben eine hohe Morbidit\u00e4t und Mortalit\u00e4t. Bei vorbestehendem Alkoholabusus und dringlicher Operationsindikation sollte ein intensiveres Monitoring erfolgen. Bei An\u00e4mie, Kachexie, Hypalbumin\u00e4mie sowie ASA-Score &gt;\u20092 stellt m\u00f6glicherweise die Diskontinuit\u00e4tsresektion den geeigneteren Eingriff dar.<\/jats:p>","DOI":"10.1055\/a-1291-8293","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T23:48:19Z","timestamp":1607557699000},"page":"44-57","source":"Crossref","is-referenced-by-count":3,"title":["Palliativchirurgie beim kolorektalen Karzinom \u2013 welche Faktoren k\u00f6nnen bei der Wahl des operativen Vorgehens helfen?"],"prefix":"10.1055","volume":"146","author":[{"given":"Ralf","family":"Konopke","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Allgemein- und Viszeralchirurgie, Elblandklinikum Riesa, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Schubert","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin 2, Elblandklinikum Riesa, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"St\u00f6ltzing","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Allgemein- und Viszeralchirurgie, Elblandklinikum Riesa, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Thomas","sequence":"additional","affiliation":[{"name":"Medizinische Klinik I, Universit\u00e4tsklinikum Dresden, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Kersting","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Allgemeine, Viszeral-, Thorax- und Gef\u00e4\u00dfchirurgie, Greifswald, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Denz","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein- und Viszeralchirurgie, Universit\u00e4tsklinikum Erlangen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,12,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4172\/2165-7386.1000132","article-title":"Overview of Palliative Surgery: Principles and Priorities","volume":"2","author":"J Hanna","year":"2012","journal-title":"J Palliative Care Med"},{"issue":"S 02","key":"ref2","first-page":"S13","article-title":"[Palliative treatment for colorectal cancer]","volume":"32","author":"S Hegewisch-Becker","year":"2009","journal-title":"Onkologie"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/j.1463-1318.2005.00862.x","article-title":"Feasibility and morbidity of reversal of Hartmann\u02bcs","volume":"7","author":"S Banerjee","year":"2005","journal-title":"Colorectal Dis"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s11605-009-1084-3","article-title":"Conventional and laparoscopic reversal of the Hartmann procedure: a review of literature","volume":"14","author":"B J van de Wall","year":"2010","journal-title":"J Gastrointest Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s10151-017-1735-4","article-title":"Reversal of Hartmann\u02bcs procedure: still a complicated operation","volume":"22","author":"N Horesh","year":"2018","journal-title":"Tech Coloproctol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1007\/s10350-005-0168-8","article-title":"Hartmann\u02bcs reversal is associated with high postoperative adverse events","volume":"48","author":"H N Aydin","year":"2005","journal-title":"Dis Colon Rectum"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.amjsurg.2013.05.006","article-title":"Complications of Hartmann takedown in a decade of preferred primary anastomosis","volume":"207","author":"A Garber","year":"2014","journal-title":"Am J Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"D Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1055\/s-0032-1332980","article-title":"Leitlinie der Deutschen Gesellschaft f\u00fcr Ern\u00e4hrungsmedizin (DGEM). 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