Torres Marla L, McCafferty Michael H, Jorden Jeffrey
University of Louisville, Louisville, Kentucky 40202, USA.
Am Surg. 2010 Sep;76(9):974-6.
Neoadjuvant chemoradiation therapy (NCRT) has become the standard treatment for locally advanced rectal cancer. Subsequent downstaging can make identification of the primary tumor challenging. Complete pathologic response rates of 8 per cent to 27 per cent are seen with current NCRT regimen. Two patients were referred to our institution after NCRT and subsequent low anterior resection in whom no residual cancer was found in the resected specimen but who manifested cancer in the distal rectum in the early postoperative period. Resection of a locally advanced rectal cancer after NCRT associated with significant tumor shrinkage is facilitated by the surgeon's evaluation with proctoscopy and tumor tattooing before the initiation of NCRT. After NCRT, preoperative proctoscopy, distal rectal evaluation after a sphincter sparing procedure in the operating room, and thorough specimen evaluation help to insure that the surgeon has removed the rectal cancer with an appropriate margin. These cases emphasize how important it is for the surgeon to be involved in the staging phase of managing the patient with rectal cancer.
新辅助放化疗（NCRT）已成为局部晚期直肠癌的标准治疗方法。随后的肿瘤降期会使原发性肿瘤的识别具有挑战性。当前的NCRT方案可实现8%至27%的完全病理缓解率。两名患者在接受NCRT及随后的低位前切除术后转诊至我院，其切除标本中未发现残留癌，但术后早期在远端直肠出现癌灶。在NCRT开始前，通过直肠镜检查和肿瘤标记，外科医生对NCRT后肿瘤显著缩小的局部晚期直肠癌进行切除更为便利。NCRT后，术前直肠镜检查、在手术室进行保留括约肌手术后对远端直肠的评估以及对标本的彻底评估，有助于确保外科医生已以适当的切缘切除直肠癌。这些病例强调了外科医生参与直肠癌患者分期阶段的重要性。
