摘要
以外科手术为中心的多学科综合治疗是局部进展期直肠癌的主要治疗方法,术前放化疗在降低直肠癌局部复发率方面体现出一定疗效。对于术前放化疗在直肠癌综合治疗中的价值,临床医师还需要从外科角度理性认识,术前放化疗可能增加术后吻合口漏并发症发生率、排便功能障碍发生率,关于放化疗后手术间隔时间的选择,需要平衡放化疗治疗效果和手术切除质量的关系,放化疗后临床完全缓解的病人观察等待策略需要在严格遴选、良好沟通和密切随访下进行,对近临床完全缓解病人的直肠瘢痕或浅溃疡病灶实施局部全层切除手术需谨慎,以质量控制和降低局部复发率为目标的直肠外科新技术,如肛提肌外腹会阴联合切除术、经肛全直肠系膜切除,可能在优化直肠癌围手术期治疗策略,降低直肠癌病人治疗经济负担方面具有一定应用前景和研究价值。
Multi-disciplinary comprehensive treatment based on surgery is the mainstay of treatment for locally advanced rectal cancer.Preoperative chemoradiotherapy shows positive effect on reducing local recurrence.The value of preoperative chemoradiotherapy in rectal cancer treatment,however,requires thorough and objective assessment from surgeons’ point of view.Firstly,neoadjuvant chemoradiation might increase the incidence of postoperative anastomotic leakage and defecation dysfunction.Besides,deciding on the interval between chemoradiotherapy and operation needs carefully balancing the therapeutic effect and the quality of surgical resection.Additionally,patients presenting as clinical complete regression after chemoradiation should be strictly selected for watch-and-wait strategy,and requires good communication and close follow-ups as well.Moreover,the choose of local full-thickness excision for the scar or ulcerative lesion of patients with near clinical complete response should be made carefully.In the end,several novel rectal surgical procedures including extralevator abdominoperineal excision and transanal total mesorectal resection,which aiming at quality control and reducing local recurrence,should be adopted for their promising future for improving both perioperative therapy and the costs of rectal cancer.
作者
申占龙
叶颖江
王杉
SHEN Zhan-long;YE Ying-jiang;WANG Shan(Department of Gastroenterological Surgery,Laboratory of Surgical Oncology,Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research,Peking University People's Hospital,Beijing 100044,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第8期913-917,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目资助(No.81672375)。
关键词
直肠癌
术前放化疗
rectal cancer
preoperative chemoradiotherapy
