直肠癌术前准确分期价值及对治疗策略选择的影响

The significance of preoperative staging of rectal cancer and its effect to treatment strategy

通过术前分期检查，尽量准确了解肿瘤浸润范围．从而选择最适合病人的治疗方案，提高直肠癌治疗效果。术前局部分期检查首选直肠腔内超声及盆腔MRI检查，两种方法各有利弊，但是诊断淋巴结分期的准确率均不理想。对于严格选择的早期直肠癌可采用局部切除术，甚至可选择内镜下切除。对部分早中期直肠癌，应选择根治性手术，而且术前分期结果对于选择不同的根治术式也有帮助。对于局部晚期[T3-4期和（或）伴有区域性淋巴结转移]直肠癌采用术前新辅助放化疗再行手术；对于同时伴有远处转移的直肠癌病人，可选择新辅助化疗后再考虑手术治疗.

Preoperative staging examinations are intended to identify the extent of rectal tumor infiltration accurately so as to select optimal individualized protocols for the sake of improving therapeutic outcomes. The two imaging modalities that are most useful for locoregional staging of rectal cancer are ERUS and pelvic MRI. Although they have their pros and cons, their accuracy for lymph node staging is unsatisfactory. Local excision or even endoscopic resection is a viable option for highly selective early-stage rectal cancer. Radical resection is preferred for more advanced rectal cancer that is not candidate for local excision. Preoperative chemoradiation is usually recommended for patients with locally advanced rectal cancer （T3-4 and/or N1-2 stage without distant metastasis）. Neoadjuvant chemotherapy and surgical resection can be considered for patients with distal metastasis depending on individual conditions.