临床T4bM0期结肠癌的手术治疗决策

Surgical treatment strategy for cT4bM0 colon cancer

根据国际抗癌联盟（UICC）第7版TNM分期指南，侵犯周围脏器而无远处转移的结肠癌定义为T4bM0期。这种类型的结肠癌并不少见．而且通常是在术中探查时被发现。术中很难准确判断肿瘤与脏器之间是炎性粘连还是肿瘤侵犯．即便是术中活检亦常无法确定，而且活检有导致肿瘤细胞播散之可能，应该避免。在充分评估肿瘤可切除性之后，如果没有绝对手术禁忌证，外科医生应该遵循整块切除原则，根据受侵脏器种类、部位及范围选择合适的联合脏器切除术．力争达到Rl，切除目标，为患者带来长期生存获益：

Colon cancer may invade the adjacent organ in the absence of distant metastasis, which is called stage T4bM0 colon cancer according to the 7th edition of TNM staging system. It is not rare in clinical setting, and usually recognized intraoperatively. How to deal with this situation is a big challenge for the surgeons. It is difficult to distinguish between dense adhesion and cancerous invasion. [ntraoperative biopsy should be avoided because of the risk of tumor cell dissemination and frozen often gives false-negative results. After evaluating the resectability of the tumor sufficiently, the surgeon should make every, effort to do an en bloc muhivisceral resection and to achieve a margin-free （R0） resection if there is no absolute contraindication. This effort will bring long-term prognosis benefit for the patients with stage cT4bM0 colon cancer.