Rawat Nihit, Evans Martyn D
Advanced Pelvic Oncology Fellow, Swansea Colorectal Unit, Swansea, UK.
Swansea Colorectal Unit, Colorectal Surgeon, Morriston Hospital, Heol Maes Eglwys,, Morriston, Swansea, SA6 6NL UK.
Indian J Surg. 2014 Dec;76(6):474-81. doi: 10.1007/s12262-014-1089-3. Epub 2014 May 18.
Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).
在全直肠系膜切除术（TME）时代之前，直肠癌手术的局部复发率很高。TME技术的广泛应用以及新辅助肿瘤治疗的加入降低了局部失败率，提高了直肠癌患者的生存率。我们知识的进步、对肿瘤生物学的更好理解以及微创技术和设备的改进显著改变了直肠癌的治疗方式。本文回顾了这些变化，并提出了直肠癌管理概念化和治疗方式的范式转变，即将直肠癌的治疗分为早期肿瘤（可能适合局部切除）、TME肿瘤（通过TME进行最佳管理）和TME以外的肿瘤（通过TME平面外的多脏器切除进行最佳管理）。
