直肠癌根治术后局部复发的因素和预防要点

Predictive factors and prevention of postoperative local recurrence of rectal cancer

直肠癌根治术后局部复发已引起临床广泛关注并成为研究难点。影响直肠癌术后局部复发因素较多,但主要有肿瘤远切缘、环周切缘肿瘤浸润程度、直肠系膜切除范围,肿瘤组织分化程度,临床肿瘤TNM分期,手术方式选择等。重视手术操作规范,合理选择手术方式,术中确保远近切缘及环周切缘阴性,坚持全直肠系膜切除(TME)原则,给予新辅助放化疗等综合治疗是预防直肠癌术后复发的关键。

Postoperative local recurrence of rectal cancer is a focal and difficuh clinical problem. Predictive factors relating to locally recurrent rectal cancer are the tumor distal end incised margin, circumferential resection margins, mesorectum resection scope, the degree of the tumor histological differentiation, TNM stage and localization of the tumor, surgical experience and a suitable operation procedure for the primary tumor. To prevent local recurrence, preoperative staging of the tumor and evaluation of patients are prerequisites. Radical surgery with total mesorectum excision is criticality to ensure incised margin negative and circumferential resection margin complete without residual cancer. Neoadjuvant chemoradiotherapy is useful for decrease of local recurrence rate of rectal cancer.