外科理论与实践

外科理论与实践 >

2024 , Vol. 29 >Issue 03: 206 - 210

DOI: https://doi.org/10.16139/j.1007-9610.2024.03.04

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局部进展期直肠癌的手术时机把握

  • 谢海艇 ,
  • 胡烨婷 ,
  • 李军 ,
  • 丁克峰
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  • 1. 浙江大学医学院附属第二医院大肠外科 恶性肿瘤预警与干预教育部重点实验室，浙江 杭州 310009
    2. 消化系统医药基础研究创新中心（教育部），浙江 杭州 310058
    3. 浙江省恶性肿瘤临床医学研究中心，浙江 杭州 310058
丁克峰，E-mail：dingkefeng@zju.edu.cn

收稿日期: 2024-04-11

  网络出版日期: 2024-09-03

基金资助

浙江省重点研发计划项目“领雁”计划(2023C03049);浙江大学医学院附属第二医院临床研究基金(RCT-2019-005A)

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Optimal timing of surgery for locally advance rectal cancer: how we choose

  • XIE Haiting ,
  • HU Yeting ,
  • LI Jun ,
  • DING Kefeng
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  • 1. Department of Colorectal Surgery and Oncology (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education), the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310009, China
    2. Center for Medical Research and Innovation in Digestive System Tumors, Ministry of Education, Zhejiang Hangzhou 310058, China
    3. Zhejiang Provincial Clinical Research Center for Cancer, Zhejiang Hangzhou 310058, China

Received date: 2024-04-11

  Online published: 2024-09-03

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摘要

局部进展期直肠癌（LARC）术后具有较高的局部复发率和远处转移率，仅靠手术难以达到有效治疗。新辅助放化疗联合根治性手术是其标准治疗，可明显降低LARC的局部复发率，但却显著危害病人肛门和泌尿生殖功能，严重影响生活质量。因此如何避免目前“一刀切”的治疗模式，选择最佳的根治性手术时机，使其兼顾肿瘤学预后和生活质量是目前的研究热点和难点。笔者认为通过术前评估LARC风险，合理选择根治性手术时机是目前行之有效的策略：对术前风险评估为中低危的病人可考虑直接手术，或术前化疗联合根治性手术；对于高危病人，可通过加强术前新辅助治疗等策略，延后根治性手术时机，以改善肿瘤学预后。本文围绕LARC根治性的时机选择进行分析讨论，为后续LARC开展个体化和精细化的治疗选择提供思路。

关键词： 局部进展期直肠癌; 根治性手术; 手术时机; 新辅助放化疗

本文引用格式

谢海艇 , 胡烨婷 , 李军 , 丁克峰 . 局部进展期直肠癌的手术时机把握[J]. 外科理论与实践, 2024 , 29(03) : 206 -210 . DOI: 10.16139/j.1007-9610.2024.03.04

Abstract

Locally advanced rectal cancer (LARC) is associated with a high risk of local recurrence and distant metastasis, making it difficult to be cured by surgery alone. Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for LARC, with reduced local recurrence rates. However, neoadjuvant chemoradiotherapy is associated with patients' urogenital and sexual dysfunction, which severely affecting their quality of life. Therefore, determining the optimal timing of surgery to balance oncologic and functional outcomes is crucial and challenging. We proposed that choosing the optimal timing of surgery based on preoperative risk assessment of LARC is an effective strategy. The patients with low to moderate risk of recurrence can be considered to perform surgery directly or have preoperative chemotherapy followed by radical surgery. Patients with high risk of recurrence should extend neoadjuvant therapy before surgery to improve oncologic outcomes. In this study we explored the optimal timing of radical surgery for LARC, providing a new idea for individualized and precise treatment of LARC.

Key words： Locally advanced rectal cancer(LARC); Radical surgery; Timing for surgery; Neoadjuvant chemoradiotherapy

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