Fu Chuangang, Han Junyi
Department of Colorectal Surgery, The Affiliated Shanghai East Hospital, Tongji University, Shanghai 200120, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jun 25;20(6):618-620.
Rectal cancer with simultaneous liver metastasis is very common clinically. R0 surgical resection both for the original and metastatic tumor can achieve much better long-term oncological results. The operation types include traditional open procedures for both rectal cancer and liver metastatic resection; combination of laparoscopic resection of the rectal cancer and open procedure resection of the liver metastatic lesion; traditional laparoscopic-assisted rectal and liver metastatic tumor resection with small abdominal incision and total laparoscopic natural orifice specimen extraction surgery(NOSES) without abdominal incision. Due to the complexity of rectal anatomy and treatment strategy, leading to the difference from colon cancer with liver metastasis, and due to the effect of laparoscopic treatment, especially the 3D laparoscopy, patient selection for simultaneous resection should be well planned and individualized by surgeons based on conditions of themselves and patients.
同时性肝转移的直肠癌在临床上非常常见。对原发肿瘤和转移瘤均进行R0手术切除可取得更好的长期肿瘤学效果。手术方式包括直肠癌和肝转移瘤切除的传统开放手术;腹腔镜直肠癌切除与肝转移灶开放手术切除相结合;传统腹腔镜辅助下直肠癌和肝转移瘤切除并做小腹部切口以及无腹部切口的全腹腔镜经自然腔道标本取出手术(NOSES)。由于直肠解剖结构和治疗策略的复杂性,导致其与伴有肝转移的结肠癌有所不同,并且由于腹腔镜治疗的影响,尤其是3D腹腔镜的影响,外科医生应根据自身和患者的情况,精心规划并个体化选择同时性切除的患者。