Multimodale Rehabilitation beim Rektumkarzinom

A number of traditions within perioperative patient care have not been evaluated within clinical studies and are being questioned. Among these, lengths of preoperative n.p.o. diet, surgical approach and postoperative return to normal diet are of special interest to surgeons. Multimodal rehabilitation and surgical "fast track" programs are currently evaluating the mentioned clinical traditions. Until now no prospective clinical studies on multimodal rehabilitation and "fast track" surgery in patients with rectal cancer have been performed. Nonetheless, modifications of preparation for surgery as well as of the peri- and postoperative management will provide positive effects on patient well-being, immunological competence and recovery after surgery for rectal cancer. Major issues of multimodal rehabilitation are short preoperative fasting periods, pain therapy including thoracic peridural anesthesia and COX-II-inhibitors, transverse laparotomy or laparoskopy, early mobilization on the day of surgery as well as early post-operative return to normal protein-rich diet. Whether or not oncologic advantages may also be provided by the introduction of multimodal rehabilitation remains to be determined within prospective randomized clinical studies.