Diaconescu M, Burada F, Mirea C S, Moraru E, Ciorbagiu M C, Obleaga C V, Vilcea I D
2nd General Surgery Department, University of Medicine and Pharmacy of Craiova, Romania.
Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Romania.
Curr Health Sci J. 2018 Jan-Mar;44(1):5-13. doi: 10.12865/CHSJ.44.01.01. Epub 2018 Jan 5.
Colorectal cancer is the third most often encountered type of cancer and represents the third leading cause of cancer related deaths, on both sexes. One of the most important prognostic parameters is the tumor's stage at the time of the diagnosis. T4 cancers represent advanced tumors associated with penetration of the visceral peritoneum (T4a) and/or direct invasion in adjacent structures (T4b). Preoperative diagnosis is influenced by the inability of the existent imaging modalities to accurately differentiate the true invasion from the simple, inflammatory adherence to the neighboring structures. As a consequence surgical treatment must follow the principle of en bloc resection; however the ability of achieving an R0 resection depends on the tumor location, invaded organ, and the type of the surgical procedure required. Neoadjuvant treatment for advanced colon cancer it may be very difficult to be applied. This review is focused on preoperative workup, therapeutic strategies and subsequent results in advanced T4 colon cancers.
结直肠癌是第三大常见癌症类型，也是男女癌症相关死亡的第三大主要原因。最重要的预后参数之一是诊断时肿瘤的分期。T4期癌症代表晚期肿瘤，伴有脏腹膜穿透（T4a）和/或直接侵犯相邻结构（T4b）。术前诊断受到现有成像方式无法准确区分真正的侵犯与简单的、炎症性的与邻近结构粘连的影响。因此，手术治疗必须遵循整块切除的原则；然而，实现R0切除的能力取决于肿瘤位置、受侵器官以及所需的手术方式。对于晚期结肠癌，新辅助治疗可能很难应用。本综述聚焦于晚期T4期结肠癌的术前检查、治疗策略及后续结果。
