当前直肠癌治疗的策略

Current strategies in treatment of rectal cancer

外科手术仍是直肠癌患者治疗的首选方式,但疗效不能令人满意。直肠癌患者治疗面临3大难题,局部复发率高,术后生活质量差和长期生存率低,我们的目标是降低局部复发率。全直肠系膜切除(TME)的采用使根治性切除术后疗效有了明显的提高,局部复发率降至10%以下,5a生存率达到78%,同时保肛手术增至70%,成为直肠癌术中首选术式,另一方面术后生殖排尿功能也有了显著改善,故现在直肠癌患者术后的生活质量比过去已有了很大的提高,新辅助化放疗的应用在与TME技术结合的同时更进一步提高了局部进展期低位直肠癌(T_3和T_4病变)的手术和肿瘤学效果,全身治疗特别是新化疗药物的发展已证实可进一步提高Ⅲ期结直肠癌患者的无瘤生存和总生存率,总之,直肠癌患者的治疗进入了多学科治疗的年代,可望在新的基础上进一步有效的提高疗效。

Surgical treatment is still the first choice of management for patients with rectal cancer, but the results were unsatisfied. The difficulties in treatment of rectal cancer are high local recurrence, poor postoperative life quality and low long term survival. First of all, reduction of local recurrence should be our goal and introduction of total mesorectal excision （TME） has significantly improved the outcomes following the curative resection hence the local recurrence rate has reduced to less than 10% and 5-year survival rate has been achieved to 78%. Meanwhile, the sphincter preservation resection has been increased to 70% and become the first choice of procedures in rectal cancer surgery. On the other hand, postoperative genitourinary function has also been improved significantly, so the postoperative quality of life in patients with rectal cancer is now much better than before. Application of neoadjuvant chemoradiation has further improved the surgical and oncological results in patients with locally advanced low rectal cancer （T3 and T4 stage） when combined with TME technique. Advances of systemic therapy with new chemotherapeutic agents have been proved to further improve disease-free survival and overall survival in patients with stage Ⅲ colorectal cancer. In general, treatment for patients with rectal cancer has entered into a multidisciplinary treatment era, and the outcomes of the patients with rectal cancer may be further improved effectively upon a new basis.