Yao H W, Liu Y H
*Department of Gastrointestinal Surgery, Branch Center of General Surgery, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
Zhonghua Wai Ke Za Zhi. 2017 Jan 1;55(1):28-31. doi: 10.3760/cma.j.issn.0529-5815.2017.01.008.
Laparoscopic surgery of rectal cancer has experienced more than 20 years of technical development and clinical research. Based on the published high-level clinical trials such as COREAN, COLOR Ⅱ, ACOSOG Z6051 and ALacaRT, laparoscopic surgery is recommended as method to treat rectal cancer by the NCCN Clinical Practice Guideline on Rectal Cancer (version 1.2016) with class 2A evidence. But it is also suggested that the surgeons should have experiences of performing minimally invasive proctectomy with total mesorectal excision. It is not recommended for the cases of locally advanced disease with a threatened or high risk circumferential resection margin based on staging. For those patients with high risk tumors, open surgery is preferred. Further analysis of the clinical trials has shown that surgical technique and circumferential resection margin are the key factors that affect the outcomes of laparoscopic rectal cancer surgery. Therefore, the wide application of laparoscopic surgery in the treatment of rectal cancer still needs more evidence-based clinical trials to test and prove.
直肠癌的腹腔镜手术已经历了20多年的技术发展和临床研究。基于已发表的高水平临床试验，如COREAN、COLOR Ⅱ、美国外科医师学会肿瘤学组（ACOSOG）Z6051和ALacaRT等，《NCCN直肠癌临床实践指南》（2016年第1版）以2A类证据推荐腹腔镜手术作为治疗直肠癌的方法。但同时也建议外科医生应具备实施全直肠系膜切除的微创直肠切除术的经验。对于基于分期存在环周切缘受威胁或高风险的局部进展期疾病病例，不推荐采用该手术。对于那些具有高风险肿瘤的患者，首选开放手术。对这些临床试验的进一步分析表明，手术技术和环周切缘是影响腹腔镜直肠癌手术疗效的关键因素。因此，腹腔镜手术在直肠癌治疗中的广泛应用仍需要更多基于证据的临床试验来检验和证明。
