Kim D G, Madoff R D
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.
Semin Surg Oncol. 1998 Sep;15(2):101-13. doi: 10.1002/(sici)1098-2388(199809)15:2<101::aid-ssu7>3.0.co;2-3.
Conservative surgical techniques are an alternative to radical surgery for selected patients with rectal carcinoma. The goals of conservative management are to select patients with low risk for nodal metastases and achieve local tumor control while preserving anal sphincter function. Patient selection is critical to achieve this outcome because properly selected patients can obtain results comparable to radical surgery. Selection is based on preoperative histologic characteristics and endorectal ultrasonography. Predictors of pelvic lymph node metastasis risk include tumor grade, depth of penetration, mucinous features, and vascular and lymphatic invasion. Endorectal ultrasound (ERUS) is important in accurately staging the lesion by identifying both depth of invasion and presumptive nodal status. The options for local therapy reviewed include techniques of full-thickness local excision and ablative procedures including endocavitary irradiation, electrocoagulation, and laser therapy. The techniques of full-thickness transanal excision and endocavitary irradiation are described with results from the University of Minnesota experience.
对于部分直肠癌患者，保守手术技术是根治性手术的替代方案。保守治疗的目标是选择淋巴结转移风险低的患者，在保留肛门括约肌功能的同时实现局部肿瘤控制。患者选择对于实现这一结果至关重要，因为选择恰当的患者可获得与根治性手术相当的效果。选择基于术前组织学特征和直肠内超声检查。盆腔淋巴结转移风险的预测因素包括肿瘤分级、浸润深度、黏液特征以及血管和淋巴管侵犯。直肠内超声（ERUS）对于通过识别浸润深度和推测的淋巴结状态来准确分期病变很重要。所回顾的局部治疗选项包括全层局部切除技术和消融手术，如腔内照射、电凝和激光治疗。描述了全层经肛门切除和腔内照射技术以及明尼苏达大学的经验结果。
