Heald Richard John, Santiago Ines, Pares Oriol, Carvalho Carlos, Figueiredo Nuno
Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal.
Clin Colon Rectal Surg. 2017 Nov;30(5):324-332. doi: 10.1055/s-0037-1606109. Epub 2017 Nov 27.
This article discusses the local control of primary rectal cancer and its locoregional spread in the light of modern advances. In recent years, the use of neoadjuvant chemoradiation has spread widely. However, its true benefit is not always balanced with its morbidities. Often total mesorectal excision (TME) is the best option. We will discuss the indications for immediate surgery for chemoradiation in advance and the importance of a delay in the management plan. To understand this selection, it is mandatory to know the true extent of tissue at risk for tumor dissemination and spread. Considering that TME may be enough for many patients and that most local recurrences are failures of surgical technique we introduce a new concept of total mesorectal irradiation. This exploits the new reality that precise, focused neoadjuvant therapy can offer a better response with fewer complications. Together these important changes in cancer board (multidisciplinary team) planning can also offer selected patients complete control of their cancer with no need for surgery.
本文根据现代进展探讨原发性直肠癌的局部控制及其局部区域扩散。近年来，新辅助放化疗的应用已广泛普及。然而，其真正的益处并不总是与其发病率相平衡。全直肠系膜切除术（TME）通常是最佳选择。我们将提前讨论新辅助放化疗后立即手术的适应证以及管理计划中延迟手术的重要性。为了理解这种选择，必须了解肿瘤播散和扩散的真正危险组织范围。考虑到TME对许多患者可能就足够了，而且大多数局部复发是手术技术失败所致，我们引入了全直肠系膜照射的新概念。这利用了精确、聚焦的新辅助治疗能够以更少的并发症提供更好反应这一新情况。癌症委员会（多学科团队）规划中的这些重要变化共同作用，也可为部分患者提供无需手术即可完全控制癌症的效果。
