摘要
全直肠系膜切除术是直肠癌的标准手术方式,以此为基础的经括约肌间切除术和适形保肛术已将极低位直肠癌保肛手术推向极限.然而无论哪种手术方式,患者仍需面临造口、肛门功能不佳等问题,严重影响生命质量.对在新辅助放化疗后达到临床完全缓解的患者采用"等待观察"策略为直肠癌的治疗开启新思路,使直肠癌的非手术治疗成为可能.全程新辅助治疗使"等待观察"策略的应用范围进一步扩大,并被列入指南.而免疫治疗的兴起改变了肿瘤的治疗模式,已成为错配修复缺陷或微卫星高度不稳定晚期结直肠癌患者的一线治疗方案.增强错配修复正常或微卫星稳定的人群新辅助放疗联合免疫治疗的效果,使更多低位直肠癌患者有机会达到临床完全缓解从而进入等待观察,达到保器官保功能目的成为研究热点.笔者深入探讨低位直肠癌保肛手术现状和免疫治疗时代的保肛策略,以期为低位直肠癌的治疗提供思路.
Total mesorectal excision is the standard surgical procedure for rectal cancer.Based on this,the intersphincteric resection and conformal sphincter-preserving operation have pushed the sphincter-preserving surgery for ultra-low rectal cancer to the limit.However,no matter what kind of surgery,patients still need to face stoma or anal dysfunction,which seriously affect the quality of life.The"watch and wait"strategy for patients who achieve clinical complete response after neoadjuvant chemoradiotherapy has provided novel therapeutic method for rectal cancer,making non-surgical treatment possible.Total neoadjuvant therapy has expanded the application of the watch and wait strategy and has been written to the guidelines.Meanwhile,the rise of immuno-therapy has changed the treatment pattern of tumors.It has been the first-line treatment for advanced colorectal cancer with mismatch repair deficiency or microsatellite instability-high.As for patients with proficient mismatch repair or microsatellite stability,researches focus on how to improve the effect of neoadjuvant radiotherapy combined with immunotherapy,so that more patients with low rectal cancer have the opportunity to achieve clinical complete response and enter the watch and wait procedure,which will achieve the purpose of preserving the anus or rectum.The authors elaborate on current status of sphincter-preserving strategies for low rectal cancer and the strategies in the era of immunotherapy,in order to provide references for treatment of low rectal cancer.
作者
朱晓明
张卫
Zhu Xiaoming;Zhang Wei(Department of Colorectal Surgery,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2024年第6期795-800,共6页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(82072750)
上海申康医院发展中心研究型医师创新转化能力培训项目(SHDC2022CRT007)。
关键词
直肠肿瘤
保肛手术
保器官
免疫治疗
等待观察
Rectal neoplasms
Sphincter-preserving surgery
Organpreservation
Imm-unotherapy
Watch and wait
