Manceau G, Panis Y
Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD) Beaujon HospitalAssistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), Clichy, France -
Minerva Chir. 2015 Aug;70(4):283-96. Epub 2015 Apr 21.
Neoadjuvant chemoradiotherapy followed by total mesorectal excision is currently the standard of care for locally advanced rectal cancers. However, this therapeutic approach does not take into account response to neoadjuvant treatment, which can go up to a pathologic complete response in 10-20% of the patients. Moreover, despite its efficacy in terms of local control and survival, radical surgery is associated with a significant risk of postoperative morbidity, anastomotic leakage, permanent stoma, impaired quality of life, bowel and genitourinary dysfunction. Based on these adverse events, new strategies of organ preservation have emerged recently. They include, in case of suspicion of complete tumor response, both "watch and wait" strategy and local excision of the residual scar. They seem attractive options, both for patients and surgeons, in terms of postoperative results. But few high-quality studies are available and fears remain regarding oncologic results and reproducibility of published results. Before these strategies can be recommended, large prospective randomized studies are still needed. The aim of this review is to discuss these two options for organ preservation, based on the current literature, with a special focus on oncologic outcomes.
新辅助放化疗后行全直肠系膜切除术是目前局部晚期直肠癌的标准治疗方法。然而，这种治疗方法没有考虑到新辅助治疗的反应，在10%-20%的患者中可能出现病理完全缓解。此外，尽管根治性手术在局部控制和生存方面有效，但与术后发病率、吻合口漏、永久性造口、生活质量受损、肠道和泌尿生殖系统功能障碍的显著风险相关。基于这些不良事件，最近出现了新的器官保留策略。在怀疑肿瘤完全缓解的情况下，这些策略包括“观察等待”策略和残余瘢痕的局部切除。就术后结果而言，它们对患者和外科医生似乎都是有吸引力的选择。但高质量研究较少，对肿瘤学结果和已发表结果的可重复性仍存在担忧。在推荐这些策略之前，仍需要大型前瞻性随机研究。本综述的目的是基于当前文献讨论这两种器官保留选择，特别关注肿瘤学结果。
