Bordeianou Liliana, Maguire Lillias Holmes, Alavi Karim, Sudan Ranjan, Wise Paul E, Kaiser Andreas M
Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, ACC 460, Boston, MA, 02114, USA,
J Gastrointest Surg. 2014 Jul;18(7):1358-72. doi: 10.1007/s11605-014-2528-y. Epub 2014 May 13.
Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years.
Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.
直肠癌的治疗已发展成为一种复杂的多模式方法，生存、局部复发和生活质量参数成为相关终点。在过去100年里，低位直肠癌的外科治疗发生了巨大变化。
腹会阴联合切除术曾是所有直肠癌的标准治疗方法，但随着外科医生设计和测试新的保留括约肌、维持连续性以及进行肿瘤学上合理的超低位前切除术或局部切除术的技术，其使用频率已大大降低。直肠癌手术的进展得益于对该疾病解剖学和病理生理学的更好理解、创新的手术技术、改进的技术、多模式方法以及对患者生活质量的更多重视。曾经几乎普遍注定要阳痿和接受结肠造口术的低位直肠癌患者，现在真正有可能提高生存率、避免永久性造口并保留正常排便途径。
