直肠前切除术后吻合口复发相关对策及其争议

Treatment strategy and controversy of anastomotic recurrence after anterior resection for rectal cancer

肿瘤局部复发是直肠癌病人手术后最为重大的生存风险之一。因此,降低直肠癌根治术后的局部复发率一直是结直肠外科的主要挑战。降低吻合口复发率以及局部复发率,重点在于预防,在于原发肿瘤手术时的安全切缘以及全直肠系膜切除标本的完整性,在于围手术期肿瘤综合治疗策略的执行力度。吻合口复发以及局部复发的治疗,需要手术结合多学科综合治疗协作组(MDT)模式治疗方式。从低位前切除术(LAR)到腹会阴联合切除术(APE)手术,甚至后盆腔器官切除、全盆腔器官切除,如果能够达到R0切除,都是可选择的再次手术切除方式。如何改善病人的术后生活质量,目前尚存争议。

One of the most important survival risks for patients with rectal cancer is local recurrence.Therefore,reducing the local recurrence rate after radical resection of rectal cancer has always been the main challenge for colorectal surgery.To reduce the recurrence of anastomosis and local recurrence,the key lies in the prevention,in the safe resection margin of primary tumor operation and the integrity of total mesorectal resection specimen,in the implementation of perioperative comprehensive treatment strategy.The treatment of anastomotic recurrence and local recurrence requires surgery combined with multidisciplinary team mode.From LAR to APE surgery,even posterior pelvic resection and total pelvic resection,if R0 resection can be achieved,all of the procedures are the alternatives of reoperation.How to improve the postoperative quality of life of patients remains controversial.