Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Surgery, King Faisal University, Alahsa, Saudi Arabia.
Yonsei Med J. 2021 Mar;62(3):187-199. doi: 10.3349/ymj.2021.62.3.187.
The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional outcomes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. Intraoperative nerve damage or combined excision is the primary reason for sexual and urinary dysfunction. In the past, these forms of damage could be attributed to the lack of anatomical knowledge and poor visualization of the pelvic autonomic nerve. With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.
直肠癌手术的主要目标是实现肿瘤学上安全的切除，即根治性切除并保证足够的安全切缘。全直肠系膜切除术已被引入直肠癌的根治性手术中，在局部复发和癌症特异性生存方面取得了显著改善的肿瘤学结果。除了肿瘤学结果外，接受直肠癌手术的患者的功能结果，如排尿和性功能，也得到了强调，以提高生活质量。术中神经损伤或联合切除是导致性和尿功能障碍的主要原因。过去，这些形式的损伤可能归因于缺乏解剖知识和对骨盆自主神经的不良可视化。随着微创手术的采用，现在可以可视化神经结构并对直肠系膜进行精细解剖。作为采用该技术的领先医院，我们在直肠癌手术领域采用了微创平台（腹腔镜、机器人辅助手术），并在全球范围内标准化了该技术。在这里，我们根据在 Severance 医院的经验，回顾了一种基于标准化技术的直肠癌手术，提出了一些实用的技术提示，并讨论了该领域的几个有争议的问题。
