Gu J, Gao Q K
Department of Gastrointestinal Surgery III, Peking University Cancer Hospital & Institute, Beijing 100142, China Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing 100144, China.
Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing 100144, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Mar 25;26(3):215-221. doi: 10.3760/cma.j.cn441530-20221123-00488.
In recent years, with advances in pelvic oncology and surgical techniques, surgeons have redefined the boundaries of pelvic surgery. Combined pelvic exenteration is now considered the treatment of choice for some patients with locally advanced and locally recurrent rectal cancer, but it is only performed in a few hospitals in China due to the complexity of the procedure and the large extent of resection, complications, and high perioperative mortality. Although there have been great advances in oncologic drugs and surgical techniques and equipment in recent years, there are still many controversies and challenges in the preoperative assessment of combined pelvic organ resection, neoadjuvant treatment selection and perioperative treatment strategies. Adequate understanding of the anatomical features of the pelvic organs, close collaboration of the clinical multidisciplinary team, objective assessment and standardized preoperative combination therapy creates the conditions for radical surgical resection of recurrent and complex locally advanced rectal cancer, while the need for rational and standardized R0 resection still has the potential to bring new hope to patients with locally advanced and recurrent rectal cancer.
近年来，随着盆腔肿瘤学和外科技术的进步，外科医生重新定义了盆腔手术的边界。联合盆腔脏器切除术目前被认为是一些局部晚期和局部复发性直肠癌患者的首选治疗方法，但由于该手术操作复杂、切除范围大、并发症多以及围手术期死亡率高，在中国只有少数几家医院开展。尽管近年来肿瘤药物以及手术技术和设备有了很大进展，但在联合盆腔脏器切除的术前评估、新辅助治疗选择和围手术期治疗策略方面仍存在许多争议和挑战。充分了解盆腔器官的解剖特征、临床多学科团队的密切协作、客观评估以及标准化的术前联合治疗为复发性和复杂局部晚期直肠癌的根治性手术切除创造了条件，而合理、标准化的R0切除需求仍有可能给局部晚期和复发性直肠癌患者带来新的希望。
