Borstlap W A A, van Oostendorp S E, Klaver C E L, Hahnloser D, Cunningham C, Rullier E, Bemelman W A, Tuynman J B, Tanis P J
Department of Surgery, Academic Medical Center, University of Amsterdam, the Netherlands.
Department of Surgery, VU Medical Center, Amsterdam, the Netherlands.
Colorectal Dis. 2017 Nov 14. doi: 10.1111/codi.13960.
The high morbidity associated with radical resection for rectal cancer is an incentive for surgeons to adopt strategies aimed at organ preservation, particularly for early disease. There are a number of different approaches to achieve this. In this study we have collated current national and international guidelines to produce a synopsis to support this changing practice.
The databases PubMed, Embase, Trip database, national guideline clearinghouse, BMJ Best practice were interrogated. Guidelines published before 2010 were excluded. The AGREE-II tool was used for quality assessment.
24 guidelines were drawn from 2278 potential publications. A consensus exists for local excision for "low risk" T1 rectal cancer but there is no agreement how to stratify the risk of treatment failure. There is a low level of agreement for rectal preservation for more advanced disease but when mentioned is recommended for unfit patients or in th context of a clinical trial. Guidelines are inconsistent with respect to surveillance in node negative disease and after, complete response to chemoradiotherapy CONCLUSION: According to current guidelines and consensus statements organ preservation for rectal cancer beyond low risk T1, is still considered experimental and only indicated in patients unsuitable for radical surgery.. Follow up strategies and cN0 staging deserve attention and highlight the need for high quality clinical trials. This article is protected by copyright. All rights reserved.
直肠癌根治性切除术后的高发病率促使外科医生采取旨在保留器官的策略，尤其是针对早期疾病。有多种不同方法可实现这一目标。在本研究中，我们整理了当前的国内和国际指南，以生成一份综述来支持这种不断变化的做法。
对PubMed、Embase、Trip数据库、国家指南交换中心、BMJ最佳实践等数据库进行了检索。排除2010年之前发表的指南。使用AGREE-II工具进行质量评估。
从2278篇潜在出版物中提取了24份指南。对于“低风险”T1期直肠癌的局部切除存在共识，但对于如何分层治疗失败风险尚无一致意见。对于更晚期疾病的直肠保留，共识程度较低，但在提及保留直肠时，推荐用于不适合手术的患者或在临床试验背景下。在淋巴结阴性疾病以及对放化疗完全缓解后的监测方面，指南存在不一致之处。结论：根据当前指南和共识声明，对于低风险T1期以上的直肠癌，保留器官仍被视为试验性的，仅适用于不适合根治性手术的患者。随访策略和cN0分期值得关注，并凸显了高质量临床试验的必要性。本文受版权保护。保留所有权利。
