Plum Patrick S, Chon Seung-Hun, Alakus Hakan, Mehdorn Matthias, Stelzner Sigmar, Thieme René, Kreuser Nicole, Gockel Ines
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, Cologne, Germany.
Visc Med. 2025 Apr;41(2):74-79. doi: 10.1159/000542838. Epub 2025 Jan 6.
Colorectal cancer (CRC) during pregnancy can be a challenging situation due to the spatial confinement of the tumor with the growing uterus carrying the fetus. It is one of the more common tumor entities occurring in pregnant women, and therefore, it has to be taken into account if "patients describe suspicious" symptoms.
Diagnosis and treatment are complex and require a specialized multidisciplinary team of visceral oncologists with expertise in colorectal surgery, gastrointestinal oncologists, gynecologists, obstetricians, and neonatologists to coordinate the optimal treatment plan with the patient. Multimodal treatment options depend on gestational age and tumor stage. Radical surgical oncologic therapy at the latest possible stage of pregnancy is often the only feasible, potentially curative treatment option. Chemotherapy and radiotherapy should be postponed to the postpartum period, if possible. Neonatological aspects, including the high risk of serious complications for the infant during and after anesthesia for oncologic surgery, such as cerebral hemorrhage, pulmonary hypoplasia, and necrotizing enterocolitis, must always be in the focus when considering the optimal timing of surgery, as well as the prognosis of the mother concerning her tumor.
Treatment of CRC during pregnancy is based on highly individualized therapeutic decisions rather than on standardized guideline recommendations. Surgical resection via partial colectomy, anterior rectal resections, and abdominoperineal extirpations are feasible. However, it has always to be considered if surgery has to be performed in elective situations or damage control procedures due to emergencies, such as mechanical ileus or perforations with intra-abdominal sepsis.
由于肿瘤与怀有胎儿的子宫不断增大之间存在空间限制，孕期结直肠癌（CRC）的情况颇具挑战性。它是孕妇中较为常见的肿瘤类型之一，因此，如果“患者描述有可疑”症状，就必须予以考虑。
诊断和治疗较为复杂，需要一个由结直肠外科专家、胃肠肿瘤学家、妇科医生、产科医生和新生儿科医生组成的专业多学科团队，以便与患者协调制定最佳治疗方案。多模式治疗方案取决于孕周和肿瘤分期。在尽可能晚的孕期阶段进行根治性手术肿瘤治疗通常是唯一可行的、有可能治愈的治疗选择。如有可能，化疗和放疗应推迟至产后阶段。在考虑手术的最佳时机以及母亲肿瘤的预后时，必须始终关注新生儿方面的问题，包括肿瘤手术麻醉期间及之后婴儿出现严重并发症的高风险，如脑出血、肺发育不全和坏死性小肠结肠炎。
孕期结直肠癌的治疗基于高度个体化的治疗决策，而非标准化的指南建议。通过部分结肠切除术、直肠前切除术和腹会阴联合切除术进行手术切除是可行的。然而，始终需要考虑手术是在择期情况下进行，还是由于紧急情况（如机械性肠梗阻或伴有腹腔内感染的穿孔）而进行损伤控制手术。
