2017年NCCN《直肠癌临床实践指南》外科诊治部分更新解读

Interpretation of surgical treatment part of updated NCCN clinical practice guideline for rectal cancer

2017年美国国家综合癌症网络(NCCN)《直肠癌临床实践指南》在诊断、治疗、随访等方面进行了诸多更新。主要内容包括:肿瘤出芽增加为恶性息肉局部切除术后不良组织病理学特征;c T1N0M0直肠癌经肛局部切除后病理学评估为高危病人增加了放化疗后等待观察和化疗选择;c T1-2N0M0直肠癌经腹手术后病理学检查提示为p T3-4N0M0的后续治疗增加了观察和单纯化疗选择;术前接受新辅助治疗的直肠癌病人术后不必一定行辅助治疗;可切除同时性直肠转移癌删除了围手术期靶向药物;可切除同时性直肠转移癌增加了直肠肿瘤术前短程放疗;谨慎地肯定了肿瘤细胞减灭术联合腹腔化疗在结直肠腹膜转移癌病人中的作用。

NCCN（National Comprehensive Cancer Network） clinical practice guideline updated in many areas of diagnosis, treatment and follow-up in 2017. Main content include tumor budding is added to an adverse histological feature with adverse outcome after operation of malignant polyps; options of ＂watch and wait＂ after chemoradiation and chemotherapy is recommended to cT1N0M0 rectal cancer patients who underwent transanal local resection with unfavorable histopathological features; postoperative treatment of pT3-4N0M0 rectal cancer patients whose preoperative stage is cT1-2N0M0 could be ＂watch and wait＂ or chemotherapy; the patients underwent preoperative therapy is not necessary to get postoperative treatment; perioperative target therapy is deleted from the strategy of resectable synchronous liver metastasis of rectal cancer;short course radiotherapy is permitted in the treatment of primary tumor of resectable liver metastasis of rectal cancer; the effect of cytoreductive surgery combined with intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis of colorectal cancer is affirmed cautiously.