Colorectal Surgery Department, Metropolitan Hospital, Athens, Greece.
Department of Radiology, Medical School, Aretaieion Hospital, University of Athens, Athens, Greece.
Updates Surg. 2021 Apr;73(2):513-526. doi: 10.1007/s13304-020-00903-6. Epub 2020 Oct 27.
The present review attempts to assess whether upper rectal cancer (URC) should be treated either as colon cancer or as rectal one, namely to be managed with upfront surgery without neo-adjuvant treatment and partial mesorectal excision (PME), or with neo-adjuvant short course radiotherapy (SCRT) or chemoradiotherapy (CRT) as indicated, followed by surgery with total mesorectal excision. Reports from current evidence including studies, reviews and various guidelines are conflicting. Main reasons for inability to reach safe conclusions are (i) the various anatomical definitions of the rectum and its upper part, (ii) the inadequate preoperative local staging,(iii) the heterogeneity of selection criteria for the neo-adjuvant treatment,(iv) the different neo-adjuvant treatment regimens, and(v) the variety in the extent of surgical resection, among the studies. Although not adequately supported, locally advanced URC can be treated with neo-adjuvant CRT provided the lesion is within the radiation field of safety, and a PME if the lower border of the tumour is located above the anterior peritoneal reflection. There is evidence that adjuvant chemotherapy is of benefit in high-risk stage II and stage III lesions.
本综述旨在评估高位直肠癌（URC）应作为结肠癌还是直肠癌进行治疗，即是否应采用不进行新辅助治疗和部分直肠系膜切除术（PME）的 upfront 手术治疗，或根据需要采用新辅助短程放疗（SCRT）或放化疗（CRT），然后进行全直肠系膜切除术。来自现有证据的报告，包括研究、综述和各种指南，存在冲突。无法得出明确结论的主要原因是：（i）直肠及其上部的解剖定义不同；（ii）术前局部分期不足；（iii）新辅助治疗选择标准的异质性；（iv）新辅助治疗方案不同；（v）研究之间手术切除范围不同。尽管没有充分的支持，但对于位于安全放疗范围内的局部晚期 URC，可以采用新辅助 CRT 治疗，如果肿瘤下缘位于前腹膜反射上方，则采用 PME。有证据表明，辅助化疗对高危 II 期和 III 期病变有益。
