早期直肠癌的诊治现状与全程监测
收稿日期: 2024-04-07
网络出版日期: 2024-09-03
基金资助
国家重点研发计划(2022YFA1304000);国家自然科学基金重点联合项目(U21A20344)
Diagnosis, treatment and full-process surveillance of early rectal cancer
Received date: 2024-04-07
Online published: 2024-09-03
早期直肠癌是指浸润深度局限于黏膜及黏膜下层的任意大小的直肠上皮性肿瘤，无论有无淋巴结转移。不伴局部淋巴结转移的早期直肠癌，局部切除是主要治疗方式之一。内镜黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）、经肛门内镜显微手术（TEM）和经肛门微创手术（TAMIS）等技术的发展，给早期直肠癌的治疗带来了更多的选择。8%~12%的早期直肠癌病人存在局部淋巴结转移，因此仍需接受全直肠系膜切除术（TME）。现行指南推荐，具有高危病理特征的早期直肠癌需追加补救性根治手术。各种微创、低位保肛手术如经自然腔道取标本手术（NOSES）、经肛门全直肠系膜切除术（TaTME）、经括约肌间切除术（ISR）、适形切除功能保肛手术（CSPO）更好地实现了保肛保功能的目标。早期直肠癌总体预后良好，但其全程监测随诊同样重要。早期直肠癌的早诊早治及全程监测理念的革新，内镜技术及外科技术的发展，必将进一步提高早期直肠癌诊疗的规范化。
兰平 , 陈永乐 , 何晓生 . 早期直肠癌的诊治现状与全程监测[J]. 外科理论与实践, 2024 , 29(03) : 197 -205 . DOI: 10.16139/j.1007-9610.2024.03.03
Early rectal cancer is defined as any size of rectal epithelial tumor with infiltration depth limited to the mucosa and submucosa, regardless of with or without lymph node metastasis. Local resection is one of the main treatment methods for early rectal cancer without local lymph node metastasis. The development of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) has brought more options for the treatment of early rectal cancer. About 8%-12% of early rectal cancer patients have local lymph node metastasis and therefore still require total mesorectal excision (TME). The current guidelines recommend that early rectal cancer with high-risk pathological features requires additional salvage radical surgery. Various minimally invasive and anal sphincter-preserving surgical techniques, such as natural orifice specimen extraction surgery (NOSES), transanal total mesorectal excision (TaTME), intersphincteric resection (ISR), and conformal sphincter-preserving operation (CSPO), have better achieved the goal of anal sphincter preservation and anal function preservation. The overall prognosis of early rectal cancer is good, but full-process surveillance is equally important. With the innovation of early diagnosis, early treatment and full-process surveillance, the development of endoscopic and surgical techniques will further improve the standardization of diagnosis and treatment for early rectal cancer.
| [1] | Global cancer burden growing, amidst mounting need for services[J]. Saudi Med J, 2024, 45(3):326-327. |
| [2] | HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China,2022[J]. J Natl Cancer Cent, 2024, 4(1):47-53. |
| [3] | WOLF A M D, FONTHAM E T H, CHURCH T R, et al. Colorectal cancer screening for average-risk adults:2018 guideline update from the American Cancer Society[J]. CA Cancer J Clin, 2018, 68(4):250-281. |
| [4] | 中华医学会消化内镜学分会结直肠学组. 中国结直肠癌及癌前病变内镜诊治共识(2023,广州)[J]. 中华消化内镜杂志,2023, 40(7):505-520. |
| Colorectal Group,Digestive Endoscopy Branch of Chinese Medical Association. Expert consensus on endoscopic diagnosis and treatment for colorectal cancer and precancerous lesions in China (2023,Guangzhou)[J]. Chin J Dig Endosc,2023, 40(7):505-520. | |
| [5] | 国家卫生健康委员会医政司,中华医学会肿瘤学分会. 国家卫健委中国结直肠癌诊疗规范(2023版)[J]. 中国实用外科杂志, 2023, 43(6):602-630. |
| Department of Medical Administration, National Health Comimission;Chinese Society of Oncology. Chinese protocol of diagnosis and treatment of colorectal cancer of the National Health Commission (2023 edition)[J]. Chin J Pract Surg, 2023, 43(6):602-630. | |
| [6] | YOU Y N, HARDIMAN K M, BAFFORD A, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of rectal cancer[J]. Dis Colon Rectum, 2020, 63(9):1191-1222. |
| [7] | MORINO M, RISIO M, BACH S, et al. Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference[J]. Surg Endosc, 2015, 29(4):755-773. |
| [8] | ALLEMANI C, MATSUDA T, DI CARLO V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J]. Lancet, 2018, 391(10125):1023-1075. |
| [9] | 胡茜玥, 刘正, 王锡山. 结直肠癌筛查策略的研究现状与思考[J]. 中国全科医学, 2021, 24(33):4165-4171. |
| HU X Y, LIU Z, WANG X S. Colorectal cancer screening: current strategies and thoughts[J]. Chin Gen Pract, 2021, 24(33):4165-4171. | |
| [10] | 国家癌症中心中国结直肠癌筛查与早诊早治指南制定专家组. 中国结直肠癌筛查与早诊早治指南(2020,北京)[J]. 中华肿瘤杂志,2021, 43(1):16-38. |
| National Cancer Center, China, Expert Group of the Development of China Guideline for the Screening, Early Detection and Early Treatment of Colorectal Cancer. China guideline for the screening, early detection and early treatment of colorectal cancer (2020, Beijing)[J]. Chin J Oncol,2021, 43(1):16-38. | |
| [11] | GLYNNE-JONES R, WYRWICZ L, TIRET E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4):iv263. |
| [12] | BENSON A B, VENOOK A P, AL-HAWARY M M, et al. Rectal cancer, version 2.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20(10):1139-1167. |
| [13] | TOMITA N, ISHIDA H, TANAKAYA K, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2020 for the clinical practice of hereditary colorectal cancer[J]. Int J Clin Oncol, 2021, 26(8):1353-1419. |
| [14] | BISSCHOPS R, EAST J E, HASSAN C, et al. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2019[J]. Endoscopy, 2019, 51(12):1155-1179. |
| [15] | CHEN H S, SHEEN-CHEN S M. Synchronous and “early” metachronous colorectal adenocarcinoma: analysis of prognosis and current trends[J]. Dis Colon Rectum, 2000, 43(8):1093-1099. |
| [16] | SCHOELLHAMMER H F, GREGORIAN A C, SARKISYAN G G, et al. How important is rigid proctosigmoidoscopy in localizing rectal cancer?[J]. Am J Surg, 2008, 196(6):904-908;discussion 908. |
| [17] | SAVIDES T J, MASTER S S. EUS in rectal cancer[J]. Gastrointest Endosc, 2002, 56(4 Suppl):S12-S18. |
| [18] | SHIMURA T, EBI M, YAMADA T, et al. Magnifying chromoendoscopy and endoscopic ultrasonography measure invasion depth of early stage colorectal cancer with equal accuracy on the basis of a prospective trial[J]. Clin Gastroenterol Hepatol, 2014, 12(4):662-668. |
| [19] | YIMEI J, REN Z, LU X, et al. A comparison between the reference values of MRI and EUS and their usefulness to surgeons in rectal cancer[J]. Eur Rev Med Pharmacol Sci, 2012, 16(15):2069-2077. |
| [20] | GAO Y, LI J, MA X, et al. The value of four imaging modalities in diagnosing lymph node involvement in rectal cancer: an overview and adjusted indirect comparison[J]. Clin Exp Med, 2019, 19(2):225-234. |
| [21] | TAYLOR F G, QUIRKE P, HEALD R J, et al. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage Ⅰ, Ⅱ, and Ⅲ rectal cancer best managed by surgery alone: a prospective, multicenter, European study[J]. Ann Surg, 2011, 253(4):711-719. |
| [22] | ENGELEN S M, MAAS M, LAHAYE M J, et al. Modern multidisciplinary treatment of rectal cancer based on staging with magnetic resonance imaging leads to excellent local control, but distant control remains a challenge[J]. Eur J Cancer, 2013, 49(10):2311-2320. |
| [23] | AN C, HUH H, HAN K H, et al. Use of preoperative MRI to select candidates for local excision of MRI-staged T1 and T2 rectal cancer: can MRI select patients with N0 tumors?[J]. Dis Colon Rectum, 2015, 58(10):923-930. |
| [24] | BROWN G, RICHARDS C J, BOURNE M W, et al. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison[J]. Radiology, 2003, 227(2):371-377. |
| [25] | GONDAL G, GROTMOL T, HOFSTAD B, et al. Biopsy of colorectal polyps is not adequate for grading of neoplasia[J]. Endoscopy, 2005, 37(12):1193-1197. |
| [26] | PETRELLI N J, LéTOURNEAU R, WEBER T, et al. Accuracy of biopsy and cytology for the preoperative diagnosis of colorectal adenocarcinoma[J]. J Surg Oncol, 1999, 71(1):46-49. |
| [27] | BOSCH S L, TEERENSTRA S, DE WILT J H, et al. Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions[J]. Endoscopy, 2013, 45(10):827-834. |
| [28] | 周欣毅, 丁克峰, 李军. 早期结直肠癌的淋巴结转移风险评估体系的现状及研究进展[J]. 中华胃肠外科杂志, 2023, 26(5):492-498. |
| ZHOU X Y, DING K F, LI J. Progress in evaluating the risk of lymph node metastasis in early colorectal cancer[J]. Chin J Gastrointest Surg, 2023, 26(5):492-498. | |
| [29] | WANG K, HE H, LIN Y, et al. A new clinical model for predicting lymph node metastasis in T1 colorectal cancer[J]. Int J Colorectal Dis, 2024, 39(1):46. |
| [30] | BORSCHITZ T, WACHTLIN D, M?HLER M, et al. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer[J]. Ann Surg Oncol, 2008, 15(3):712-720. |
| [31] | LEZOCHE E, BALDARELLI M, LEZOCHE G, et al. Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy[J]. Br J Surg, 2012, 99(9):1211-1218. |
| [32] | COOPER G S, XU F, BARNHOLTZ SLOAN J S, et al. Management of malignant colonic polyps: a population-based analysis of colonoscopic polypectomy versus surgery[J]. Cancer, 2012, 118(3):651-659. |
| [33] | OKA S, TANAKA S, SAITO Y, et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan[J]. Am J Gastroenterol, 2015, 110(5):697-707. |
| [34] | KIRIYAMA S, SAITO Y, YAMAMOTO S, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis[J]. Endoscopy, 2012, 44(11):1024-1030. |
| [35] | NAKAMURA F, SAITO Y, HARUYAMA S, et al. Short-term prospective questionnaire study of early postoperative quality of life after colorectal endoscopic submucosal dissection[J]. Dig Dis Sci, 2017, 62(12):3325-3335. |
| [36] | TOMIKI Y, KAWAI M, KAWANO S, et al. Endoscopic submucosal dissection decreases additional colorectal resection for T1 colorectal cancer[J]. Med Sci Monit, 2018, 24:6910-6917. |
| [37] | LUIGIANO C, CONSOLO P, SCAFFIDI M G, et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up[J]. Endoscopy, 2009, 41(10):829-835. |
| [38] | FUJIYA M, TANAKA K, DOKOSHI T, et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection[J]. Gastrointest Endosc, 2015, 81(3):583-595. |
| [39] | 中国抗癌协会大肠癌专业委员会TEM学组. 经肛门内镜微创手术(TEM)技术专家共识(2016)[J]. 中华胃肠外科杂志, 2016, 19(7):731-733. |
| Tem Group of the Colorectal Cancer Professional Committee of the Chinese Anti Cancer Association. Expert consensus on transanal endoscopic minimally invasive surgery (TEM) technology (2016)[J]. Chin J Gastrointest Surg, 2016, 19(7):731-733. | |
| [40] | CUNNINGHAM C. Local excision for early rectal cancer[J]. Clin Oncol (R Coll Radiol), 2023, 35(2):82-86. |
| [41] | 王锡山. 结肠直肠肿瘤经自然腔道取标本手术适应证选择的规范与共识[J]. 外科理论与实践, 2018, 23(5):394-397. |
| WANG X S. Criterion and consensus of indications for natural orfice specimen extraction surgery in colorectal tumor[J]. J Surg Concepts Pract, 2018, 23(5):394-397. | |
| [42] | 中国医师协会结直肠肿瘤专业委员会,中国NOSES联盟. 结直肠肿瘤经自然腔道取标本手术指南(2023版)[J]. 中华结直肠疾病电子杂志, 2023, 12(2):89-99. |
| Professional Committee of Colorectal Tumour, Chinese Medical Doctors' Association,China Noses Alliance. Guidelines for natural orifice specimen extraction surgery in colorectal neoplasm(V.2023)[J]. Chin J Colorectal Dis(Electronic Edition), 2023, 12(2):89-99. | |
| [43] | 中华医学会外科学分会结直肠外科学组,中华医学会外科学分会腹腔镜与内镜外科学组. 直肠癌经肛全直肠系膜切除中国专家共识及临床实践指南(2019版)[J]. 中国实用外科杂志, 2019, 39(11):1121-1128. |
| Chinese Society of Colorectal Surgery, Laparoscopic and Endoscopic Surgery Group of the Chinese Medical Association Surgical Branch. Chinese expert consensus and clinical practice guidance for transanal total mesorectal excision in rectal cancer (2019 Edition)[J]. Chin J Pract Surg, 2019, 39(11):1121-1128. | |
| [44] | 中华医学会外科学分会结直肠外科学组. 低位直肠癌经括约肌间切除术中国专家共识(2023版)[J]. 中华胃肠外科杂志, 2023, 26(6):536-547. |
| Chinese Society of Colorectal Surgery. Chinese expert consensus on intersphincteric resection for low rectal cancer (2023 edition)[J]. Chin J Gastrointest Surg, 2023, 26(6):536-547. | |
| [45] | 中华医学会外科学分会结直肠外科学组, 中国医师协会结直肠肿瘤专业委员会,中国医师协会肛肠医师分会. 低位直肠癌适形保肛手术操作标准(2023版)[J]. 中华胃肠外科杂志, 2023, 26(10):907-914. |
| Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, Colorectal Cancer Committee of the Chinese Medical Doctor Association,Anorectal Branch of Chinese Medical Doctor Association. Standardized surgical procedure of conformal sphincter-preservation operation for low rectal cancer (2023 edition)[J]. Chin J Gastrointest Surg, 2023, 26(10):907-914. | |
| [46] | 中华医学会肿瘤学分会早诊早治学组. 中国结直肠癌早诊早治专家共识(2023版)[J]. 中华普通外科学文献(电子版), 2024, 18(1):1-13. |
| Expert Group on Early Diagnosis and Treatment of Cancer, Chinese Society of Oncology,Chinese Medical Association. Expert consensus on the early diagnosis and treatment of colorectal cancer in China (2023 edition)[J]. Chin Arch Gen Surg(Electronic Edition), 2024, 18(1):1-13. | |
| [47] | MATHEW R. Radical surgery versus organ preservation for early-stage rectal cancer[J]. Lancet Gastroenterol Hepatol, 2021, 6(4):263. |
| [48] | JAVE M A, SHAMIM S, SLAWIK S, et al. Long-term outcomes of patients with poor prognostic factors following transanal endoscopic microsurgery for early rectal cancer[J]. Colorectal Dis, 2021, 23(8):1953-1960. |
| [49] | OUCHI A, KOMORI K, MASAHIRO T, et al. How does omitting additional surgery after local excision affect the prognostic outcome of patients with high-risk T1 colorectal cancer?[J]. Ann Surg, 2024, 279(2):290-296. |
| [50] | OKA S, TANAKA S, KAJIWARA Y, et al. Treatment decision for locally resected T1 colorectal carcinoma-verification of the Japanese guideline criteria for additional surgery based on long-term clinical outcomes[J]. Am J Gastroenterol, 2024, 119(8):1483-1491. |
| [51] | 中国直肠癌新辅助治疗后等待观察数据库研究协作组, 中华医学会外科学分会结直肠外科学组, 中国医师协会结直肠肿瘤医师专业委员会, 等. 直肠癌新辅助治疗后等待观察策略中国专家共识(2024版)[J]. 中华胃肠外科杂志, 2024, 27(4):301-315. |
| Chinese Watch & Wait Database Research Cooperation Group (CWWD), Chinese Society of Colorectal Surgery, Chinese Medical Association, Colorectal Cancer Physician Specialty Committee, Colorectal Cancer Committee, et al. Chinese expert consensus on the watch and wait strategy in rectal cancer patients after neoadjuvant treatment (2024 version)[J]. Chin J Gastrointest Surg, 2024, 27(4):301-315. |
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