Distal dissection in total mesorectal excision, and preoperative chemoradiotherapy and lateral lymph node dissection for rectal cancer
Distal dissection in total mesorectal excision, and preoperative chemoradiotherapy and lateral lymph node dissection for rectal cancer
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全直肠系膜切除术中的远端清扫术以及直肠癌的术前放化疗和侧方淋巴结清扫术
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
T. Tokoro
中科院分区：
文献类型：
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作者：
Jin;K. Okuno;T. Tokoro
全直肠系膜切除术（TME）的局部复发率明显低于传统手术。我们回顾了从MEDLINE数据库中识别的所有相关文章，并阐明了TME的基本原理。很明显远端壁内扩散是罕见的。即使存在，这种扩散也不可能延伸超过2 cm。关注直肠系膜癌沉积物的数据表明，直肠系膜距离肿瘤远端至少4-5 cm的清除应该是足够的。TME对大多数中低位直肠肿瘤应行。这并不意味着在每种情况下都需要在同一水平上分割肠管。可以将远端直肠系膜从肠管上剥离，因此，如果这样的操作可以确保保留括约肌，那么肠壁的远端分割线可以在肿瘤下方至少2cm处进行。在直肠上三分之一的癌症病例中，直肠系膜和肠管可以安全地在肿瘤下方5 cm处分开，而不会危及复发率。我们的研究结果表明，TME是直肠癌的一种基本治疗方法，侧淋巴结清扫和术前放化疗是晚期直肠癌应考虑的额外治疗方法。
The local recurrence rate after total mesorectal excision (TME) appears to be markedly lower than that after conventional operations. We reviewed all relevant articles identified from the MEDLINE databases and clarified the rationale for TME. It is clear that distal intramural spread is rare. Even when present, such spread is not likely to extend beyond 2 cm. Data with attention to mesorectal cancer deposits suggest that mesorectal clearance of at least 4–5 cm distal to the tumor should be sufficient. TME should be performed for most tumors of the mid- and lower rectum. This does not mean that the gut tube needs to be divided at the same level in every case. Dissection of the distal mesorectum off the gut tube can be performed, so the distal line of division of the bowel wall can be made at a minimum of 2 cm below the tumor if such a maneuver would ensure that the sphincters are preserved. In cases with cancer in the upper third of the rectum, the mesorectum and gut tube can safely be divided 5 cm below the tumor without jeopardizing the recurrence rates. Our findings indicate that TME is an essential treatment approach for rectal cancer, and lateral lymph node dissection and preoperative chemoradiotherapy are additional therapies that should be considered for advanced rectal cancer.
影响因子：
8.4
作者：
Witkamp, AJ;de Bree, E;Zoetmulder, FAN
通讯作者：
Zoetmulder, FAN