摘要
目前,外科手术仍然是结直肠癌患者的主要治疗手段。随着肿瘤外科手术的发展,腹腔镜和经肛全直肠系膜切除等微创技术和侧方淋巴结清扫、联合脏器切除等个体化手术技术的进步,传统手术相关病死率降低。新辅助治疗可降低局部复发和远处转移,改善患者生存。辅助治疗的优化,缩短了治疗周期,降低治疗风险及减少不良反应。新辅助免疫治疗成为错配修复缺陷/微卫星高度不稳定型结直肠癌治疗新标准,但对大部分无错配修复缺陷/微卫星稳定型结直肠癌表现不佳,还需突破结直肠癌基因表型的限制。笔者认为:未来研究应筛选出更多能预测治疗反应的生物标志物,研发新的联合治疗方案,使结直肠癌治疗更加个体化和精确化,最终让更多患者获益。
At present,surgical resection remains as the main treatment for patients with colorectal cancer(CRC).Alongside the progress in oncologic surgical technique,minimally invasive approaches,such as laparoscopy and transanal total mesorectal excision(taTME),and individualized surgical options,such as lateral lymph node dissection and multivisceral resection,the patient mortality associated with traditional surgical approaches has been improved.Neoadjuvant therapy can decrease local recurrence and distant metastasis,and improve the survival of patients.The optimization of adjuvant therapy shortens treatment cycle,reduces treatment risk and toxicities.Recently,neoadjuvant immunotherapy has become the new standard of the treatment for mismatch repair-deficient or microsatellite instability high CRC.However,it shows unsatisfactory outcomes in patients with mismatch repair-proficient/microsatellite stable CRC,which needs overcoming the limi-tation of CRC genephenotype.With more researches on CRC,the more biomarkers predicting the response to treatment will be found and the novel comprehensive treatment of CRC will be developed,which will make the treatment of CRC more individualized and accurate,and finally benefit more patients.
作者
杨盈
孟文建
王自强
Yang Ying;Meng Wenjian;Wang Ziqiang(Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2022年第6期753-765,共13页
Chinese Journal of Digestive Surgery
基金
四川省科技计划项目(重点研发计划2021YFS0025)
四川大学华西医院学科卓越发展1·3·5工程项目(20HXJS003)。
关键词
结肠肿瘤
直肠肿瘤
综合治疗
手术
新辅助化疗
化疗
免疫治疗
Colon neoplasms
Rectal neoplasms
Comprehensive treatment
Surgery
Neoadjuvant chemotherapy
Chemotherapy
Immunotherapy
