van Vugt Jeroen L A, Reisinger Kostan W, Derikx Joep P M, Boerma Djamila, Stoot Jan H M B
Jeroen LA van Vugt, Djamila Boerma, Department of Surgery, St Antonius Hospital, 3430 EM Nieuwegein, The Netherlands.
World J Gastroenterol. 2014 Sep 21;20(35):12445-57. doi: 10.3748/wjg.v20.i35.12445.
During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.
在过去几十年中，结直肠癌手术在围手术期取得了一些重大进展。术前对营养、虚弱和肌肉减少症进行风险评估，随后采取干预措施优化患者状况或调整手术策略，有助于改善术后结果。强化康复计划或快速康复手术也缩短了住院时间并减少了总体并发症，同时不影响患者安全。在因肿瘤安全性不确定而最初犹豫不决之后，术中护理最显著的改进是腹腔镜手术的引入。腹腔镜结肠癌和直肠癌手术具有更好的短期效果，而在生存和复发率方面的长期效果相当。然而，直肠手术的长期结果仍有待观察。尽管多项改进使吻合口漏的管理得到了更好的控制，但早期识别吻合口漏仍然是一项挑战。
