Daniel Jin-Keat Lee, Gaitri Sadadcharam, Kok-Yang Tan, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore.
World J Gastroenterol. 2017 Jun 21;23(23):4170-4180. doi: 10.3748/wjg.v23.i23.4170.
Locally recurrent rectal cancer (LRRC) is a complex disease with far-reaching implications for the patient. Until recently, research was limited regarding surgical techniques that can increase the ability to perform an resection with negative margins. This has changed in recent years and therefore outcomes for these patients have improved. Novel radical techniques and adjuncts allow for more radical resections thereby improving the chance of negative resection margins and outcomes. In the past contraindications to surgery included anterior involvement of the pubic bone, sacral invasions above the level of S2/S3 and lateral pelvic wall involvement. However, current data suggests that previously unresectable cases may now be feasible with novel techniques, surgical approaches and reconstructive surgery. The publications to date have only reported small patient pools with the research conducted by highly specialised units. Moreover, the short and long-term oncological outcomes are currently under review. Therefore although surgical options for LRRC have expanded significantly, one should balance the treatment choices available against the morbidity associated with the procedure and select the right patient for it.
局部复发性直肠癌（LRRC）是一种复杂的疾病，对患者有深远的影响。直到最近，关于能够提高切除阴性边缘能力的手术技术的研究还很有限。近年来，这种情况发生了变化，因此这些患者的治疗效果得到了改善。新的根治性技术和辅助手段可以进行更激进的切除，从而提高阴性切缘和治疗效果的机会。过去，手术的禁忌症包括耻骨前受累、S2/S3 以上的骶骨侵犯和骨盆侧壁受累。然而，目前的数据表明，以前无法切除的病例现在可能可以通过新的技术、手术方法和重建手术来实现。迄今为止，这些出版物仅报告了少数患者病例，且研究由高度专业化的单位进行。此外，目前正在对短期和长期的肿瘤学结果进行审查。因此，尽管 LRRC 的手术选择有了显著的扩大，但应该根据手术相关的发病率来平衡可提供的治疗选择，并为患者选择正确的治疗方案。
