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手术、内镜、经肛门切除术及放疗方式治疗直肠癌的疗效对比如何?

What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer?

作者信息

Isaic Alexandru, Motofelea Alexandru Cătălin, Costachescu Dan, Pop Gheorghe Nicusor, Totolici Bogdan, Popovici Dorel, Diaconescu Razvan Gheorghe

机构信息

IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania.

Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

出版信息

Healthcare (Basel). 2023 Aug 20;11(16):2347. doi: 10.3390/healthcare11162347.

Abstract

BACKGROUND

Rectal cancer is a significant healthcare burden, and effective treatment is crucial. This research aims to compare the effectiveness of surgical and endoscopic resection, transanal resection, and radiotherapy.

METHODS

A literature analysis was conducted in order to identify relevant studies, by comparing the different surgical approaches and variables affecting treatment decisions. The findings were analyzed and synthesized to provide a comprehensive overview.

RESULTS

Surgical treatment, particularly TME (total mesorectal excision), proved consistent efficacy in achieving complete tumor resection and improving long-term survival. Endoscopic treatment and transanal resection techniques were promising for early-stage tumors but were associated with higher local recurrence rates. Radiotherapy, especially in combination with chemotherapy, played a crucial role in locally advanced cases, improving local control and reducing recurrence risk. Patient data, tumor characteristics, and healthcare system factors were identified as important factors in treatment modality selection.

CONCLUSION

Surgical treatment, specifically TME, remains the recommended standard approach for rectal cancer, providing excellent oncological outcomes. Endoscopic treatment and transanal resection techniques can be considered for selected early-stage cases, while radiotherapy is beneficial for locally advanced tumors. Treatment decisions should be personalized based on patient and tumor characteristics, considering the available resources and expertise within the healthcare system.

摘要

背景

直肠癌是一项重大的医疗负担,有效的治疗至关重要。本研究旨在比较手术切除、内镜切除、经肛切除和放射治疗的有效性。

方法

通过比较不同的手术方法和影响治疗决策的变量进行文献分析,以确定相关研究。对研究结果进行分析和综合,以提供全面的概述。

结果

手术治疗,尤其是全直肠系膜切除术(TME),在实现肿瘤完全切除和提高长期生存率方面显示出一致的疗效。内镜治疗和经肛切除技术对早期肿瘤有前景,但局部复发率较高。放射治疗,特别是与化疗联合使用时,在局部晚期病例中发挥关键作用,改善局部控制并降低复发风险。患者数据、肿瘤特征和医疗系统因素被确定为治疗方式选择的重要因素。

结论

手术治疗,特别是TME,仍然是直肠癌推荐的标准方法,可提供良好的肿瘤学结果。对于选定的早期病例可考虑内镜治疗和经肛切除技术,而放射治疗对局部晚期肿瘤有益。应根据患者和肿瘤特征进行个性化治疗决策,同时考虑医疗系统内可用的资源和专业知识。

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本文引用的文献

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Colorectal cancer: A health and economic problem.结直肠癌:一个健康和经济问题。
Best Pract Res Clin Gastroenterol. 2023 Oct;66:101839. doi: 10.1016/j.bpg.2023.101839. Epub 2023 May 23.
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Management of the malignant colorectal polyp.恶性大肠息肉的管理
Curr Probl Surg. 2022 May;59(5):101124. doi: 10.1016/j.cpsurg.2022.101124. Epub 2022 Feb 10.
10
When is transanal endoscopic surgery appropriate?经肛门内镜微创手术适用于哪些情况?
Surg Oncol. 2022 Aug;43:101773. doi: 10.1016/j.suronc.2022.101773. Epub 2022 Apr 15.

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