术前放化疗治疗局部晚期直肠癌的外科问题
Surgical issues in locally advanced rectal cancer treated by preoperative chemoradiotherapy.
作者信息
Lim Seok-Byung, Kim Jin Cheon
机构信息
Department of Surgery, Asan Medical Center, Institute of Innovative Cancer Research, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
J Korean Surg Soc. 2013 Jan;84(1):1-8. doi: 10.4174/jkss.2013.84.1.1. Epub 2012 Dec 26.
Abstract
The standard treatment for patients with locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. This approach is supported by randomized trials, but there are still many unanswered questions about the multimodal management of rectal cancer. In surgical terms, these include the optimal time interval between completion of chemoradiotherapy and surgery; adequate distal resection margin and circumferential radial margin; sphincter preservation; laparoscopic surgery; and conservative management, including a 'wait and see' policy and local excision. This review considers these controversial issues in preoperative chemoradiotherapy.
摘要
局部晚期直肠癌患者的标准治疗方法是术前放化疗，然后行全直肠系膜切除术。这种方法得到了随机试验的支持，但关于直肠癌的多模式治疗仍有许多未解决的问题。从外科角度来看，这些问题包括放化疗结束与手术之间的最佳时间间隔；足够的远端切缘和环周切缘；保留括约肌；腹腔镜手术；以及保守治疗，包括“观察等待”策略和局部切除。本综述探讨了术前放化疗中这些有争议的问题。
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