外科理论与实践 ›› 2021, Vol. 26 ›› Issue (04): 290-296.doi: 10.16139/j.1007-9610.2021.04.004
顾晋1,2(
)
收稿日期:2021-07-19
出版日期:2021-07-25
发布日期:2021-08-31
作者简介:顾晋,E-mail:
GU Jin1,2()
Received:2021-07-19
Online:2021-07-25
Published:2021-08-31
中图分类号:
顾晋. 局部晚期结肠直肠癌治疗和联合脏器切除[J]. 外科理论与实践, 2021, 26(04): 290-296.
GU Jin. Treatment and combined viscerectomy for locally advanced colorectal cancer[J]. Journal of Surgery Concepts & Practice, 2021, 26(04): 290-296.
图1
右半结肠癌可疑侵犯周围脏器（图片资料来自笔者手术团队） A：术前腹部CT检查提示肿瘤可疑侵犯十二指肠（箭头处）;B：术前腹部CT检查提示肿瘤可疑侵犯肝脏、腹壁（箭头处）;C：术中发现肿瘤巨大,与十二指肠、肝脏、腹壁粘连;D：术后标本,实现R0切除。
图2
右半结肠癌侵犯十二指肠（图片资料来自笔者手术团队） A：术前腹部CT检查提示肿瘤侵犯十二指肠（箭头处）;B：T1WI;C：T2WI;D：术后标本,肿瘤侵透十二指肠肠腔（箭头处）,实现R0切除。
图3
左半结肠癌侵犯脾门（图片资料来自笔者手术团队）A：术中见结肠肿瘤侵犯脾门（箭头处）;B：先断降结肠,显露横结肠;C：处理脾血管,将肿瘤及脾门侵犯组织一并切除。
图4
中段直肠癌侵犯膀胱（图片资料来自笔者手术团队） A：术前CT检查见直肠肿瘤侵犯膀胱（箭头处）;B：手术切除范围模式图;C：切除标本,受累膀胱壁完整切除（箭头处）。
图5
低位直肠癌侵犯骶骨（图片资料来自笔者手术团队） A、B：术前MRI检查见直肠肿瘤侵犯骶骨>S3（箭头处）;C：暴露骶骨并在S3处离断;D、E：Hartmann术,并修复盆底;F：切除标本,纵向切开;G：标本局部放大,直肠肿瘤及受累骶骨完整切除（箭头处）。
图6
全盆腔脏器切除术+输尿管皮肤造口（男性） （图片资料来自笔者手术团队） A、B：完整切除直肠、肛门、精囊腺、前列腺、膀胱及远端输尿管;C、D：近端输尿管皮肤造口;E：切除标本,缝线牵拉膀胱（前面观）。
| [1] | Zhang S, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2015[J]. J Nat Cancer Cent, 2021, 1(1):2-11. |
| [2] | 中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020版)[J]. 中华消化外科杂志, 2020, 19(6):563-588. |
| [3] | Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual[M].8th ed. Chicago: Springer International Publishing, 2017:256-262. |
| [4] | 彭俊杰, 朱骥, 刘方奇, 等. 中国局部进展期直肠癌诊疗专家共识[J]. 中国癌症杂志, 2017, 27(1):41-80. |
| [5] | Davies ML, Harris D, Davies M, et al. Selection criteria for the radical treatment of locally advanced rectal cancer[J]. Int J Surg Oncol, 2011, 2011:678506. |
| [6] | van de Velde CJ, Boelens PG, Borras JM, et al. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum[J]. Eur J Cancer, 2014, 50(1):1.e1-1.e34. |
| [7] |
Nicholson BD, Shinkins B, Mant D. Blood measurement of carcinoembryonic antigen level for detecting recurrence of colorectal cancer[J]. JAMA, 2016, 316(12):1310-1311.
doi: 10.1001/jama.2016.11212 pmid: 27673308 |
| [8] | Anania G, Resta G, Marino S, et al. Treatment of co-lorectal cancer: a multidisciplinary approach[J]. J Gas-trointest Cancer, 2019, 50(3):458-468. |
| [9] |
Martenson JA Jr, Willett CG, Sargent DJ, et al. Phase Ⅲ study of adjuvant chemotherapy and radiation therapy compared with chemotherapy alone in the surgical adjuvant treatment of colon cancer: results of intergroup protocol 0130[J]. J Clin Oncol, 2004, 22(16):3277-3283.
pmid: 15249584 |
| [10] |
Cukier M, Smith AJ, Milot L, et al. Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience[J]. Eur J Surg Oncol, 2012, 38(8):677-682.
doi: 10.1016/j.ejso.2012.05.001 pmid: 22632848 |
| [11] |
Feeney G, Sehgal R, Sheehan M, et al. Neoadjuvant radiotherapy for rectal cancer management[J]. World J Gastroenterol, 2019, 25(33):4850-4869.
doi: 10.3748/wjg.v25.i33.4850 URL |
| [12] |
Gerard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase Ⅲ trial ACCORD 12/0405-Prodige 2[J]. J Clin Oncol, 2010, 28(10):1638-1644.
doi: 10.1200/JCO.2009.25.8376 URL |
| [13] |
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer[J]. N Engl J Med, 2001, 345(9):638-646.
doi: 10.1056/NEJMoa010580 URL |
| [14] |
Hupkens BJP, Maas M, Martens MH, et al. Organ preservation in rectal cancer after chemoradiation: should we extend the observation period in patients with a clinical near-complete response?[J]. Ann Surg Oncol, 2018, 25(1):197-203.
doi: 10.1245/s10434-017-6213-8 pmid: 29134378 |
| [15] |
Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer[J]. Surg Clin North Am, 2017, 97(3):529-545.
doi: 10.1016/j.suc.2017.01.004 URL |
| [16] |
楼征, 张卫. 梗阻性结直肠癌造口方式选择[J]. 中国实用外科杂志, 2019, 39(12):1354-1356.
doi: 10.19538/j.cjps.issn1005-2208.2019.12.29 |
| [17] |
McLaughlin C, Kim NK, Bandyopadhyay D, et al. Adjuvant radiation therapy for T4 non-rectal colon adenocarcinoma provides a cause-specific survival advantage: a SEER database analysis[J]. Radiother Oncol, 2019, 133: 50-53.
doi: 10.1016/j.radonc.2018.11.026 URL |
| [18] | 陈瑛罡, 刘彦龙, 刘正, 等. 原发ⅡC期结直肠癌患者炎性浸润与癌性浸润预后的比较研究[J]. 中华胃肠外科杂志, 2011, 14(4):267-270. |
| [19] | 顾晋. 局部晚期结直肠癌的治疗不能轻易放弃外科手术[J]. 中华胃肠外科杂志, 2018, 21(3):241-245. |
| [20] | Yamaguchi T, Takahashi H, Kagawa R, et al. The role of prophylactic bilateral oophorectomy at the time of initial diagnosis of a unilateral ovarian metastasis in cases with colorectal adenocarcinoma[J]. Hepatogastroenterology, 2008, 55(82-83):434-437. |
| [21] | 万远廉, 姜勇. 全盆腔脏器切除术在局部复发直肠癌中的应用[J]. 中华胃肠外科杂志, 2010, 13(8):562-564. |
| [22] |
Quasar Collaborative Group, Gray R, Barnwell J, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study[J]. Lancet, 2007, 370(9604):2020-2029.
doi: 10.1016/S0140-6736(07)61866-2 URL |
| [23] |
Gahagan JV, Whealon MD, Phelan MJ, et al. Improved survival with adjuvant chemotherapy in locally advanced rectal cancer patients treated with preoperative chemoradiation regardless of pathologic response[J]. Surg Oncol, 2020, 32:35-40.
doi: S0960-7404(18)30348-7 pmid: 31726418 |
| [24] |
Moertel CG, Fleming TR, Macdonald JS, et al. Le-vamisole and fluorouracil for adjuvant therapy of resected colon carcinoma[J]. N Engl J Med, 1990, 322(6):352-358.
doi: 10.1056/NEJM199002083220602 URL |
| [25] |
Ning Y, Armin G, Zhang W, et al. Plastin polymorphisms predict gender- and stage-specific colon cancer recurrence after adjuvant chemotherapy[J]. Mol Cancer Ther, 2014, 13(2):528-539.
doi: 10.1158/1535-7163.MCT-13-0646 pmid: 24170770 |
| [26] |
Morris M, Platell C, Fritschi L, et al. Failure to complete adjuvant chemotherapy is associated with adverse survival in stage Ⅲ colon cancer patients[J]. Br J Cancer, 2007, 96(5):701-707.
doi: 10.1038/sj.bjc.6603627 URL |
| [27] |
Xu Z, Mohile SG, Tejani MA, et al. Poor compliance with adjuvant chemotherapy use associated with poorer survival in patients with rectal cancer: an NCDB analysis[J]. Cancer, 2017, 123(1):52-61.
doi: 10.1002/cncr.30261 URL |
| [28] |
Dobie SA, Baldwin LM, Dominitz JA, et al. Completion of therapy by Medicare patients with stage Ⅲ colon cancer[J]. J Natl Cancer Inst, 2006, 98(9):610-619.
doi: 10.1093/jnci/djj159 URL |
| [29] |
Becerra AZ, Aquina CT, Mohile SG, et al. Variation in delayed time to adjuvant chemotherapy and disease-specific survival in stage Ⅲ colon cancer patients[J]. Ann Surg Oncol, 2017, 24(6):1610-1617.
doi: 10.1245/s10434-016-5622-4 pmid: 27738848 |
| [30] |
Yu S, Mamtani R, O'Hara MH, et al. Comparative effectiveness of total neoadjuvant therapy versus standard adjuvant chemotherapy for locally advanced rectal cancer[J]. Clin Colorectal Cancer, 2021, 20(2):121-129.
doi: 10.1016/j.clcc.2021.01.001 URL |
| [31] | Xie Y, Lin J, Wang X, et al. The addition of preoperative radiation is insufficient for lateral pelvic control in a subgroup of patients with low locally advanced rectal cancer: a post-hoc study of a randomized controlled trial[J]. Dis Colon Rectum,2021-05-13[online ahead of print]. |
| [32] |
Martenson JA Jr, Willett CG, Sargent DJ, et al. Phase Ⅲ study of adjuvant chemotherapy and radiation therapy compared with chemotherapy alone in the surgical adjuvant treatment of colon cancer: results of intergroup protocol 0130[J]. J Clin Oncol, 2004, 22(16):3277-3283.
pmid: 15249584 |
| [33] |
Ludmir EB, Arya R, Wu Y, et al. Role of adjuvant radiotherapy in locally advanced colonic carcinoma in the modern chemotherapy era[J]. Ann Surg Oncol, 2016, 23(3):856-862.
doi: 10.1245/s10434-015-4907-3 pmid: 26480849 |
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