Liska D, Weiser M R
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Minerva Chir. 2010 Apr;65(2):181-96.
Colorectal adenocarcinoma is the second leading cause of cancer deaths in Western countries. Rectal cancer comprises approximately 25% of the malignancies arising in the large bowel. However, the past two decades have seen many major advances in the diagnosis and treatment of this disease. While surgery is still the cornerstone of curative therapy, a multidisciplinary approach including neoadjuvant chemoradiotherapy has resulted in significantly improved outcomes. Information concerning the T, N, M stage and the exact location of tumor in relation to the anal verge are of crucial importance when planning a curative rectal cancer resection. Preoperative staging, utilizing a combination of diagnostic modalities, must be undertaken to determine whether or not neoadjuvant therapy is indicated. In radical resection of locally advanced low rectal cancer, several unique surgical management issues should be considered: 1) total mesorectal excision (TME); 2) longitudinal and circumferential resection margins; 3) autonomic nerve preservation (ANP); 4) sphincter preservation versus abdominoperineal resection (APR); 5) restoration of bowel continuity; and 6) laparoscopic versus open resection. The surgeon must first strive to achieve an oncologic cure, but whenever possible this should be undertaken with the goal of maintaining the patient's quality of life. The purpose of this review is to outline the critical surgical issues involved in management of locally advanced low rectal cancer.
在西方国家，结直肠癌是癌症死亡的第二大主要原因。直肠癌约占大肠恶性肿瘤的25%。然而，在过去二十年中，这种疾病的诊断和治疗取得了许多重大进展。虽然手术仍然是根治性治疗的基石，但包括新辅助放化疗在内的多学科方法已显著改善了治疗效果。在计划根治性直肠癌切除术时，有关T、N、M分期以及肿瘤相对于肛缘的确切位置的信息至关重要。必须采用多种诊断方式进行术前分期，以确定是否需要新辅助治疗。在局部晚期低位直肠癌的根治性切除术中，应考虑几个独特的手术管理问题：1）全直肠系膜切除术（TME）；2）纵向和环周切缘；3）自主神经保留（ANP）；4）保留括约肌与腹会阴联合切除术（APR）；5）肠道连续性的恢复；6）腹腔镜与开放手术切除。外科医生必须首先努力实现肿瘤学治愈，但只要有可能，就应以维持患者生活质量为目标进行手术。本综述的目的是概述局部晚期低位直肠癌管理中涉及的关键手术问题。
