低位直肠癌新辅助治疗后临床完全缓解病人处理策略

Management of clinical complete response after neoadjuvant chemoradiotherapy in low rectal cancer

对于局部进展期低位直肠癌,目前的标准治疗方案为术前新辅助放化疗后行全直肠系膜切除(TME),该方案中,新辅助治疗在降低局部复发率及提高保肛率方面的作用已得到公认,但手术仍导致部分病人面临永久性造口及生活质量下降的风险。临床观察发现有一部分肿瘤在新辅助治疗后能达到临床完全缓解甚至病理学完全缓解,部分病人未行根治性手术也有良好的预后。因此,有学者提出对于放化疗后临床完全缓解的病例可考虑行局部切除的微创手术或仅给予密切观察的观点,近年来已有越来越多的研究探讨这种器官保留策略的可行性及有效性。

Neoadjuvant chemoradiotherapy （CRT） followed radical surgery including total mesorectal excision （TME） is standard treatment in patients with locally advanced rectal cancer. The benefits of neoadjuvant CRT have been well documented and include tumor regression and downstaging associated with increased tumor respectability,reduced local recurrence and a higher rate of sphincter preservation. Radical surgery for rectal cancer carries a high risk of morbidity and mortality and can also greatly detract from a patient’s quality of life. In light of the significant response rates that can be achieved with preoperative CRT,some scholars have suggested limiting further surgical therapy to local excision or just wait and see. Recently, several studies have explored the feasibility and efficacy of organ-preserving strategies for low rectal cancer. Therefore, it’s a new challenge for clinician to choose how to treat the situation with clinical complete response after neoadjuvant therapy for low rectal cancer patients.