Liersch T, Langer C, Ghadimi B M, Becker H
Klinik für Allgemeinchirurgie, Universitätsklinikum Göttingen.
Chirurg. 2005 Mar;76(3):309-32; quiz 333-4. doi: 10.1007/s00104-005-1005-2.
In the last ten years, considerable progress has been achieved in the treatment of rectal cancer. According to improved interdisciplinary staging, rectal carcinomas can be treated based on a stage-dependent concept: "low-risk" pT1 (G1/G2) carcinomas can be cured by local full wall excision, while "high-risk" pT1 (G3/G4) and pT2 carcinomas require transabdominal resection. In contrast, locally advanced rectal cancers in cUICC-II/-III stages (T3/T4 or N(+)) should receive long-term, 5-FU-based, neoadjuvant chemoradiotherapy according to the excellent results of the CAO/AIO/ARO-94 trial of the German Rectal Cancer Study Group. High-quality resection must be based on radical oncologic principles such as "no-touch" technique, radicular dissection of vessels, and total mesorectal excision. Multimodal treatment is completed with adjuvant 5-FU-based chemotherapy. This therapeutic approach led to a reduction in the 5-year local recurrence rate to 6% and disease-free survival of approximately 68% in advanced rectal cancer (overall survival: 76%).
在过去十年中，直肠癌的治疗取得了显著进展。根据改进后的多学科分期，直肠癌可基于分期相关概念进行治疗：“低风险”的pT1（G1/G2）癌可通过局部全层切除治愈，而“高风险”的pT1（G3/G4）和pT2癌则需要经腹切除。相比之下，根据德国直肠癌研究组CAO/AIO/ARO-94试验的优异结果，cUICC-II/III期（T3/T4或N(+)）的局部晚期直肠癌应接受基于5-氟尿嘧啶的长期新辅助放化疗。高质量的切除必须基于“不接触”技术、血管根部解剖和直肠系膜全切除等根治性肿瘤学原则。多模式治疗以基于5-氟尿嘧啶的辅助化疗完成。这种治疗方法使晚期直肠癌的5年局部复发率降至6%，无病生存率约为68%（总生存率：76%）。
