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[结肠和直肠微创肿瘤手术的证据]

[Evidence in minimally invasive oncological surgery of the colon and rectum].

作者信息

Kastner Carolin, Reibetanz Joachim, Germer Christoph-Thomas, Wiegering Armin

机构信息

Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für operative Medizin, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.

Institut für Biochemie und molekulare Biologie I, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland.

出版信息

Chirurg. 2021 Apr;92(4):334-343. doi: 10.1007/s00104-020-01320-6.

Abstract

An essential component of the treatment of colorectal cancer is a resection of the tumor-bearing segment of the bowels. After the development of minimally invasive procedures the feasibility and safety in oncological, colorectal surgery was questioned. The broad study situation for colon cancer over the last years showed predominantly consistent benefits during the perioperative phase and non-inferiority concerning long-term oncological outcomes. The implementation of laparoscopic rectal resection was more hesitant due to the complexity of the procedure and insufficient study data; however, overall the short-term benefits seem to be maintained and laparoscopic rectal resection is thought to be noninferior to open resection in the long run even though findings on the quality of the resected specimen are heterogeneous. Accordingly, most guidelines now include a recommendation of laparoscopic resection for colorectal cancer. The limitation with respect to an achievable oncological equivalency of resection takes account of the complexity and the requirements of the intervention only in the setting of rational selection of patients and sufficient experience of the surgeon.

摘要

结直肠癌治疗的一个重要组成部分是切除肠道中带有肿瘤的部分。在微创技术发展之后,其在肿瘤性结直肠手术中的可行性和安全性受到了质疑。过去几年关于结肠癌的广泛研究情况表明,在围手术期主要有一致的益处,并且在长期肿瘤学结局方面并不逊色。由于手术的复杂性和研究数据不足,腹腔镜直肠切除术的实施更为犹豫;然而,总体而言,短期益处似乎得以维持,并且从长远来看,腹腔镜直肠切除术被认为并不逊色于开放切除术,尽管关于切除标本质量的研究结果存在差异。因此,现在大多数指南都推荐对结直肠癌进行腹腔镜切除术。关于实现肿瘤学等效切除的局限性仅在合理选择患者和外科医生有足够经验的情况下才考虑到干预的复杂性和要求。

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