Department of Surgery, Saint-Andre Hospital, Victor Segalen University of Bordeaux, Bordeaux, France.
Colorectal Dis. 2011 Nov;13 Suppl 7:37-42. doi: 10.1111/j.1463-1318.2011.02777.x.
Rectal excision is the standard in rectal cancer treatment. The morbidity of rectal excision, together with the low rate of positive lymph nodes in patients with a good response after radiochemotherapy, raises the challenging concept of organ preservation. Patients with a complete response can benefit from a nonoperative strategy based on a strict follow up. Those with a complete or subcomplete response can be treated by local excision. Limitations in accurately assessing a complete response by conventional and modern imaging modalities suggest that local excision is more appropriate for the majority of patients when organ preservation is being considered. The encouraging results of retrospective series of local excision in downstaged clinical T2/T3 low rectal cancer after radiochemotherapy, however, need to be confirmed by the ongoing multicentre phase II United States and phase III French trials before routinely proposing organ preservation in patients with a good response.
直肠切除术是直肠癌治疗的标准方法。直肠切除术的发病率，加上放射化疗后反应良好的患者淋巴结阳性率低，提出了保留器官的挑战性概念。完全缓解的患者可以受益于严格随访为基础的非手术策略。完全或部分缓解的患者可以采用局部切除的方法。常规和现代影像学方法准确评估完全缓解的局限性表明，在考虑保留器官时，局部切除更适合大多数患者。放射化疗后降期的临床 T2/T3 低位直肠癌的局部切除回顾性系列的令人鼓舞结果，需要正在进行的美国多中心 II 期和法国 III 期试验来确认，然后才能常规向反应良好的患者提出保留器官的建议。
