Division of Colorectal Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India.
Langenbecks Arch Surg. 2021 Sep;406(6):1763-1774. doi: 10.1007/s00423-021-02285-8. Epub 2021 Aug 2.
Extended and beyond total mesorectal excisions (TME) for advanced and recurrent rectal cancers are increasingly performed with acceptable oncological and functional outcomes. These are undoubtedly due to better understanding of tumor biology and improved patient selection rather than surgical valor and technical refinements alone. In the present review, we attempt to present the current surgical standards for advanced and recurrent cancers requiring surgery outside the TME planes based on involved pelvic compartments. The available procedures, their indications, and extent of resection and reconstruction are highlighted. Emphasis is on formation of dedicated exenteration teams, structured training, and referral systems that increase hospital and surgeon volume to improve patient outcomes and reduce morbidity. Areas of deficiencies in literature were recognized with regards to factors influencing recurrences, patient selection, and quality of life. Finally, the most appropriate preoperative therapy for these tumors is unclear in both the primary and recurrent settings.
对于晚期和复发性直肠癌，扩大范围的全直肠系膜切除术（TME）联合其他手术治疗方法，能够获得可接受的肿瘤学和功能结果。这些结果无疑是由于对肿瘤生物学有了更好的理解，并对患者进行了更好的选择，而不仅仅是因为手术技巧的提高。在本综述中，我们根据涉及的骨盆隔室，尝试基于 TME 平面以外的手术，为需要手术的晚期和复发性癌症提出当前的外科标准。强调了可利用的手术程序、其适应证、切除和重建的范围。重点是组建专门的根治性切除术团队、进行结构化培训和转诊系统，以提高医院和外科医生的手术量，从而改善患者的预后并降低发病率。文献中还认识到与复发相关的因素、患者选择和生活质量方面存在不足之处。最后，对于原发性和复发性直肠癌，这些肿瘤最适宜的术前治疗方法尚不清楚。
