Modern management of rectal cancer: A 2006 update
Modern management of rectal cancer: A 2006 update
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DOI：
10.3748/wjg.v12.i20.3186
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发表时间：
2006-05-28
影响因子：
4.3
通讯作者：
Guillem, Jose G.
中科院分区：
文献类型：
--
作者：
Balch, Glen C.;De Meo, Alex;Guillem, Jose G.
本综述的目的是概述早期（T1/T2 和 N0）以及局部晚期（T3/T4 和/或 N1）直肠癌患者治疗的一些重要手术问题。直肠癌手术不断发展，以实现改善局部控制和总体生存、维持生活质量以及保留括约肌、泌尿生殖和性功能的最终目标。在计划治愈性直肠癌切除术时，有关肿瘤穿透深度、直肠壁、淋巴结受累以及远处转移性疾病存在的信息至关重要。术前分期用于确定新辅助治疗的适应症以及局部切除与根治性癌症切除的适应症。对于大多数原发性肿瘤仅限于粘膜下层 (T1N0M0)、没有高风险特征且没有转移性疾病的患者，局部切除可能是治愈的。对于合适的患者，局部切除、TEM 和腹腔镜切除等微创手术可以提高患者舒适度、缩短住院时间并尽早恢复到术前活动水平。一旦肿瘤侵犯固有肌层（T2），建议对可接受的手术候选人进行根治性直肠切除术。对于无远处转移的透壁和/或淋巴结阳性疾病（T3/T4 和/或 N1）患者，根据 TME 原则进行术前放化疗，然后进行根治性切除已被广泛接受。在计划和实施局部晚期直肠癌根治手术期间，需要考虑许多手术管理问题，包括：（1）全直肠系膜切除术（TME）； (2)保留自主神经(ANP)； (3)环周切缘(CRM)； (4)远端切缘； (5) 保留括约肌和恢复肠道连续性的选择； (6) 腹腔镜手术； (7)术后生活质量。 (C) 2006 年 WJG 出版社。版权所有。
The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and N0), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration, through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1N0M0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended. In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases, preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered, including: (1) total mesorectal excision (TME); (2) autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin; (5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7) postoperative quality of life. (C) 2006 The WJG Press. All rights reserved.