Petrucciani Niccolò, Martínez-Pérez Aleix, Bianchi Giorgio, Memeo Riccardo, Brunetti Francesco, De' Angelis Nicola
Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital, AP-HP, Créteil, France.
Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain.
Minerva Chir. 2018 Feb;73(1):77-92. doi: 10.23736/S0026-4733.17.07568-X. Epub 2017 Dec 14.
In the last decades, the use of minimally invasive surgery has dramatically increased for the treatment of rectal cancer. However, no clear evidence exists on the role of laparoscopy for locally advanced rectal cancer, especially for cT4 tumors, after neoadjuvant therapy.
A literature search was performed on Embase, Medline, and Cochrane databases to identify relevant studies published up to November 2017 analyzing the outcomes of laparoscopic surgery for locally advanced rectal cancer.
Systematic reviews and meta-analyses showed that laparoscopic proctectomy is associated with faster recovery compared to open approach while oncologic and survival outcomes are equivalent. However, concerns still exist on the quality of laparoscopic mesorectal excision. In the majority of the available studies, cT4 tumors were not included, but based on few retrospective series in tertiary referral centers laparoscopic rectal resection of T4 rectal cancer appeared to be safe and feasible, with faster recovery and adequate oncologic outcomes. Robotics and transanal approaches are promising minimally invasive alternatives.
Locally advanced rectal cancers require multidisciplinary management including neoadjuvant chemo-radiotherapy and surgery. Preoperative re-staging may be useful to plan the best surgical procedure. Minimally invasive surgery, especially laparoscopy, can provide adequate outcomes in selected patients with locally advanced rectal cancer with the advantage of faster recovery compared to open surgery. However, the overall evidence is poor, and further studies are needed to elucidate the role of minimally invasive surgery for cT4 rectal cancer.
在过去几十年中，微创手术在直肠癌治疗中的应用显著增加。然而，关于腹腔镜手术在新辅助治疗后对局部晚期直肠癌，尤其是cT4肿瘤的作用，尚无明确证据。
在Embase、Medline和Cochrane数据库中进行文献检索，以确定截至2017年11月发表的分析局部晚期直肠癌腹腔镜手术结果的相关研究。
系统评价和荟萃分析表明，与开放手术相比，腹腔镜直肠切除术恢复更快，而肿瘤学和生存结果相当。然而，对腹腔镜直肠系膜切除术的质量仍存在担忧。在大多数现有研究中，未纳入cT4肿瘤，但基于三级转诊中心的少数回顾性系列研究，T4直肠癌的腹腔镜直肠切除术似乎是安全可行的，恢复更快且肿瘤学结果良好。机器人手术和经肛门手术是有前景的微创替代方法。
局部晚期直肠癌需要多学科管理，包括新辅助放化疗和手术。术前重新分期可能有助于规划最佳手术方案。微创手术，尤其是腹腔镜手术，可为部分局部晚期直肠癌患者提供良好结果，与开放手术相比具有恢复更快的优势。然而，总体证据不足，需要进一步研究以阐明微创手术在cT4直肠癌中的作用。
