直肠癌经新辅助治疗后达到临床完全缓解的评估策略及观察和等待策略

The evaluation strategy and WAW strategy of rectal cancer with a cCR after neoadjuvant treatment

术前新辅助放化疗联合全直肠系膜切除术已成为局部晚期直肠癌患者治疗的金标准。临床上部分患者经放化疗治疗后达到病理完全缓解,并与不全缓解患者相比局部复发率显著降低,生存期延长。为了避免手术相关并发症、改善患者生活质量(造瘘和保肛问题),一些机构尝试对放化疗后临床完全缓解患者采用非手术方案—"观察和等待策略"。然而,临床完全缓解并不总是预示病理完全缓解,需要综合评估策略更准确地预测哪些患者已经达到病理完全缓解来安全行"观察和等待策略"。本文就目前关于非手术方案的数据作一综述并讨论与此方案相关的持续争议。

Preoperative neoadjuvant chemoradiotherapy combined with total mesorectal excision has been the gold standard for the treatment of locally advanced patients with rectal cancer. Some patients achieve a pathologic complete response to chemoradiotherapy in clinical practice,who compared with patients with incomplete remission significantly reduced local recurrence rate,prolonged survival. In order to avoid surgical-related complications and improve the quality of life of patients（ fistula and anal preservation）,some institution try to undergo a ＂ non-operative management ＂ — ＂ watch and wait policy ＂ in patients who have a clinical complete response after chemoradiotherapy. However,a clinical complete response does not always indicate a pathologic complete response,and integrated assessment strategy is needed to predict more accurately which patients have achieved a pathologic complete responseand therefore can safely undergo a ＂ watch-and-wait policy＂. This article reviews the current data on nonoperative management and discusses on-going controversies associated with this management.