Lakkis Zaher, Panis Yves
Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University Denis-Diderot (Paris 7), Clichy, France.
Clin Colon Rectal Surg. 2017 Nov;30(5):333-338. doi: 10.1055/s-0037-1606110. Epub 2017 Nov 27.
The curative treatment of locally advanced rectal cancer is currently based on chemoradiotherapy and total mesorectal excision (TME). Laparoscopy has developed considerably because of obvious clinical benefits such as reduced pain and shorter hospital stay. Recently, several prospective randomized clinical trials with long-term follow-up have showed that laparoscopy is noninferior to laparotomy with the same oncologic outcomes in terms of survival and local control rate. However, laparoscopic TME remains a challenging procedure requiring a high level of expertise and a long learning curve to ensure an adequate and safe resection. The only relative contraindication of laparoscopic rectal surgery is T4 rectal cancer extended beyond the plane of TME. In this situation, it is reasonable to consider an open resection to avoid an uncomplete resection. In obese and elderly patients, laparoscopic TME also provides the same benefits as in nonobese and younger patients but may be more difficult to achieve. This review summarizes current knowledge on the place of laparoscopic TME in the treatment of rectal cancer.
局部晚期直肠癌的根治性治疗目前基于放化疗和全直肠系膜切除术（TME）。由于具有减少疼痛和缩短住院时间等明显临床益处，腹腔镜技术有了很大发展。最近，几项长期随访的前瞻性随机临床试验表明，就生存和局部控制率而言，腹腔镜手术在肿瘤学结局方面不劣于开腹手术。然而，腹腔镜TME仍然是一项具有挑战性的手术，需要高水平的专业技能和较长的学习曲线以确保充分且安全的切除。腹腔镜直肠手术唯一相对的禁忌证是超出TME平面的T4期直肠癌。在这种情况下，考虑行开放切除术以避免切除不完全是合理的。在肥胖和老年患者中，腹腔镜TME也能提供与非肥胖和年轻患者相同的益处，但可能更难实施。本综述总结了关于腹腔镜TME在直肠癌治疗中地位的当前知识。
