周围脏器浸润性结直肠癌的外科治疗及其评价

Evaluation and surgical treatment of colorectal cancer with adjacent organs infiltration

临床技术和研究逐步发展完善和规范了周围脏器浸润性结直肠癌的外科治疗,但仍存在许多争议。虽然,联合脏器整块切除术(enbloc multivisceral resection,MVR)以及联合远处转移灶根治性切除的创伤较大,并发症发生率及病死率较高,但严格掌握手术指征,选择恰当的手术切除范围,遵循无瘤原则,仍可获得满意的R0切除率,疗效肯定,使病人获得长期生存。术前判断肿瘤与周围脏器粘连的性质仍是目前亟待解决的难点;术中保证R0切除的同时避免盲目扩大切除范围是MVR成功实施的评价标准,既可改善病人远期生存又能保证较好的生活质量。腹腔镜实施MVR仍处于探索阶段,安全性和有效性均有待观察。预后因素尚存在一定争议,必须依照最新TNM分期对病人进行分组并评价。周围脏器浸润性结直肠癌(Ⅳ期)病例,其手术方式的选择仍存争议,推荐对此类病人进行多学科团队(MDT)讨论,制定合理规范的综合治疗方案,定期随访、评估,从而提高原发灶和远处转移病灶的根治性切除机会,延长病人的生存期。

Control trials have shaped the current surgical treatment options of the colorectal cancer with adjacent organs infiltration, hut yet there remain many unanswered questions. En bloc multivisceral resection （MVR）, even with radical resection of distant metastasis, which associated with larger surgical trauma, higher morbidity and mortality, through rigorous mastering operation indication, selection of appropriate scope of surgical resection, and following the principle of disease-free, that would receive satisfactory RO resection rate, long-term survival rate, and the curative effect is affirm. Judgment of the nature of the adhesion between tumor and adjacent organs preoperation was still a thorny problem. Guarantee R0 resection and avoid blindly expanding the scope of resection were criterions for MVR, that will improve patients long term survival rate and ensure a better quality of life. The role of laparoscopic surgery for MVR was still at the exploration phase, safety and effectiveness need further evaluation. For the IV stage of colorectal cancer with adjacent organs infiltration, a muhidisciplinary team approach in managing patients was popular where possible and recommended in some guidelines.