Kotek Jiří, Cyrany Jiří, Sirový Miroslav, Novotný Pavel, Páral Jiří
Department of Surgery, University Hospital Hradec Králové, 50005 Hradec Králové, Czech Republic.
Department of Surgery and Gastroenterology, Faculty of Medicine in Hradec Králové, Charles University, 11636 Prague, Czech Republic.
Cancers (Basel). 2025 Aug 28;17(17):2820. doi: 10.3390/cancers17172820.
Rectal cancer remains a significant clinical challenge due to its complex anatomy and the critical need to balance oncological radicality with functional preservation. Multimodal treatment strategies, including neoadjuvant therapy, advanced endoscopic techniques, and precise surgical approaches, have evolved to optimize patient outcomes. Neoadjuvant chemoradiotherapy improves resectability and local control in locally advanced tumors, while endoscopic treatment offers organ-preserving options for carefully selected early-stage cancers. Surgical resection, primarily through total mesorectal excision (TME), remains the cornerstone of curative therapy, with minimally invasive and transanal approaches enhancing precision and recovery. In advanced and recurrent cases, extended procedures such as pelvic exenteration provide potential for cure despite substantial morbidity. This review summarizes current evidence on the indications, techniques, and outcomes of neoadjuvant, endoscopic, and surgical treatments for rectal cancer, emphasizing individualized treatment planning to achieve optimal oncological and functional results.
由于直肠癌解剖结构复杂，且在肿瘤根治性与功能保留之间取得平衡至关重要，因此它仍然是一个重大的临床挑战。包括新辅助治疗、先进的内镜技术和精确的手术方法在内的多模式治疗策略已经发展起来，以优化患者的治疗效果。新辅助放化疗可提高局部晚期肿瘤的可切除性和局部控制率，而内镜治疗为精心挑选的早期癌症提供了保留器官的选择。手术切除主要通过全直肠系膜切除术（TME）进行，仍然是根治性治疗的基石，微创和经肛门入路提高了手术的精确性和患者的恢复情况。在晚期和复发病例中，尽管并发症发生率很高，但诸如盆腔脏器清除术等扩大手术仍提供了治愈的可能性。本综述总结了目前关于直肠癌新辅助治疗、内镜治疗和手术治疗的适应症、技术和结果的证据，强调个性化治疗计划以实现最佳的肿瘤学和功能结果。
