【述评】结直肠癌研究2017年热点回顾和未来展望 .pdfVIP

【述评】结直肠癌研究2017年热点回顾和未来展望

【摘要】根治性手术和(新)辅助疗法显著廷长了结直肠癌患者的

生存。在根治的前提下,微创外科和功能保护的重要性得到提升:从结肠

癌到直肠癌,腹腔镜根治术的长期生存被证实不劣于开腹;全直肠系膜切

除的经肛新入路,不但避免了为取出标本行腹部切口,还可能提升手术质

量;局部切除与“等待观察”的策略虽有保留器官的吸引力,却因临床和

影像对淋巴结和治疗应答的评估不尽人意而受掣肘。与此同时,长期确

立的围手术期方案受到全新挑战:辅助化疗缩短为3个月减少不良事件,

不影响生存;将部分或全部辅助疗程移到术前可能改善应答,以避开手术

或放疗。笔者认为,功能保留和生活质量,与生存一样,越来越成为不停演

变的结直肠癌治疗的终极目标。

【关键词】结直肠肿瘤;腹腔镜手术;肿瘤根治;功能保留;远期生存;

生活质量

基金项目:国家自然科学基金青年科学基金(3l601077)

【Abstract】Radicalsurgeriesand(neo）therapieshave

significantlyprolongedsurvivalofpatientswithcolorectalcancer.

Microinvasivesurgeryandfunctionpreservationbecomemore

importantwiththeprerequisiteofROresection.Asforcolorectal

cancer.longtermsurvivalafterlaparoscopiccurativesurgeryis

provednon-inferiortoitsopencounterpart.Thenewtransanal

approachoftotalmesorectalexcision.whileavoidingabdominal

incisionforextraction,mayaswellimprovesurgicalquality.Local

excisionandthewatchandwaitstrategy,thoughattractivefor

organ-preservation,areunderminedbysuboptimalclinicaland

radiographicassessmentoflymphnodeandtreatmentresponse,

respectively.Meanwhile,freshchangesarechallengingng-

establishedperioperativeregiments.Shorteningofadjuvant

hemotherapyto3monthsreducesadverseeventswithout

compromisingsurvival.Movingpartof,orall,adjustobefore

surgerymayimproveresponse,therebyomittingprotectoryor

radiotherapy.Tosummarize,functionpreservationandqualityof

lifehas,togetherwithsurvival,increasinglybecometheultimate

aimofcolorectalcancertreatment.afieldofconstant

evolvement

【Keywords】Colorectalneoplasms;surgery:Radical

resection;Functionpreservation;Longtermsurvival;Qualityof

life

Fundprogram:NationalNaturalScientifieFoundationof

China

结直肠癌的根治性手术和新辅助、辅助放化疗大大改善了结直肠

癌患者的治愈率和预后