Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen; Department of Radiotherapy and Oncology, Goethe University Frankfurt am Main; Department of Medical Hematology and Oncology, University Hospital Mannheim, University of Heidelberg.
Dtsch Arztebl Int. 2022 Aug 22;119(33-34):570-580. doi: 10.3238/arztebl.m2022.0254.
Colorectal cancer is one of the three most common types of cancer in Germany. Approximately 30% of these cancers are located in the rectum, corresponding to about 18 000 new cases per year.
This review is based on publications retrieved by a selective search in the PubMed database, including current guidelines and recommendations.
Specialized imaging, particularly magnetic resonance imaging, is essential for treatment planning. In very early stages of this disease, tumors without risk factors can be excised locally. Otherwise, radical surgical resection with lymphadenectomy remains the standard treatment, and can be performed either minimally invasive or open. At present, neoadjuvant treatment plans are evolving in the direction of total neoadjuvant therapy. In addition, recent studies investigate whether the improved efficacy of neoadjuvant therapy might now enable patients with a complete clinical remission to be spared from surgical resection (organ-preserving watch-and-wait strategy).
The treatment of rectal cancer is a prime example of an interdisciplinary, multimodal approach. In the past, the focus was mainly on improving oncologic outcomes; at present, increasing attention is being devoted to the patients' quality of life as well and the functional aspects of the various modes of treatment.
在德国，结直肠癌是最常见的三种癌症之一。这些癌症中约有 30%位于直肠，每年约有 18000 例新发病例。
本综述基于在 PubMed 数据库中进行选择性搜索获得的出版物，包括当前的指南和建议。
专门的影像学检查，特别是磁共振成像，对治疗计划至关重要。在疾病的早期阶段，没有风险因素的肿瘤可以局部切除。否则，根治性手术切除伴淋巴结清扫仍然是标准治疗方法，可以采用微创或开放性手术进行。目前，新辅助治疗方案正在朝着完全新辅助治疗的方向发展。此外，最近的研究探讨了新辅助治疗的疗效提高是否可以使完全临床缓解的患者免于手术切除（保留器官的观察等待策略）。
直肠癌的治疗是一个典型的多学科、多模式的方法。过去，主要重点是提高肿瘤学治疗效果；目前，越来越关注患者的生活质量以及各种治疗方式的功能方面。
