Guillemin F, Conroy T
Centre Alexis Vautrin, Vandoeuvre-les-Nancy.
Ann Chir. 1994;48(4):312-9.
The data of the literature demonstrate the poor global results of surgical treatment of the principal gastrointestinal cancers: oesophagus, stomach, bile ducts, liver, exocrine pancreas, colon and rectum. Surgery which was thought to be curative all too frequently proves to be simply a palliative procedure. The risk of failure is so high that a strategy should now be systematically adopted, combining surgery, radiotherapy, chemotherapy and symptomatic treatments. The rigor of this multidisciplinary approach is based on comparative studies confirming the prospective series and measuring the quality and duration of survival. Some protocols provide considerable improvement, for example preoperative radiotherapy of cancers of the rectum, or propose an interesting alternative such as the combination of radiotherapy and chemotherapy in cancer of the oesophagus. The participation of surgeons in multicentre prospective studies should validate and improve current oncological practice while also evaluating the contribution of a new method such as laparoscopic surgery. This commitment includes a definition of therapeutic objectives, definition of the reference treatment, selection of the criteria of the quality of the procedures involved in this treatment and objective assessment of the results.
文献数据表明，主要胃肠道癌症（食管癌、胃癌、胆管癌、肝癌、外分泌性胰腺癌、结肠癌和直肠癌）的外科治疗总体效果不佳。过去被认为具有治愈性的手术，结果常常只是一种姑息性手术。手术失败的风险如此之高，以至于现在应该系统地采用一种综合手术、放疗、化疗和对症治疗的策略。这种多学科方法的严谨性基于比较研究，这些研究证实了前瞻性系列研究，并衡量了生存质量和生存期。一些方案能带来显著改善，例如直肠癌的术前放疗，或者提出了有趣的替代方案，如食管癌的放疗与化疗联合应用。外科医生参与多中心前瞻性研究应能验证并改进当前的肿瘤治疗实践，同时评估诸如腹腔镜手术等新方法的作用。这一任务包括明确治疗目标、定义参考治疗方案、选择该治疗中所涉及程序的质量标准以及对结果进行客观评估。
