直肠癌肿瘤分期和手术方式.pptVIP

直肠癌肿瘤分期与手术方式 中山大学肿瘤防治中心 范文华 直肠癌诊治指南要点概述 ■T1的亚分期 Table 4. Haggitts subclassification of polypoidTI based 带蒂息肉癌变 Levelpon the extent of invasion of the stalk 1Haggs分类法:0-4级 Absence of invasive carcinoma 1:浸润息肉头部 Invasion into the head of the polyp ivasion into the neck 2:浸润息肉颈部 浸润息肉蒂部 Invasion into the base 4:浸润基底 扁平T1病灶 h→ Adesa ■SM1:浸润粘膜下层上1/3 ■SM2浸润粘膜下层中1/3 ■SM3:浸润粘膜卜层卜1/3 Level 1 nvasion of the into the neck of talk but a imited to the head polyp muscularis propria of the polyp Epithelium Haggitt分类法 ∷…∷……:)M5山amsa SM分级 直肠癌诊治指南要点概述 直肠癌的局部危险度分组 Risk gmup TN substage TI sml (-2) NO 板早期 早期(好) 中期(差) Early(good) cT1-2: cT3a(b) if middle or high, No (or cNI if 晚期(极差) high), mrf-, no EMVI Intermediate cT2 very low, cT3mrf- EMⅥ(壁外静脉浸润) (unless cT3a(b) and Imid- or high rectum, MRF: mesorectal fascia N1-2. EMVI+ limited TeaNo (直肠系膜筋膜) Advanced CT3mrf+ cT4a, b, lateral (ugly node+ 基于危险度分级的直肠癟 治疗原则 ■极早期组: 构成:cT1SM1(2?)No 治疗选择 ■局部切除(TEM ■如果存在预后不良因素,则根治性切除(TME)(或CRT,可能的话) sM=2,低分化,脉管浸润+ Risk group TN substage Therapeutic options Very early cIl sml(-2?)NO Local excision(TEM). If poor t s(sm≥2, high grade, V1), resection TME)(or possibly CRT)