直肠癌侧方淋巴结清扫适应证相关国内外指南解读

Interpretation of guidelines on the indication of lateral lymph node dissection for rectal cancer

随着全直肠系膜切除(TME)及新辅助治疗的应用,直肠癌的局部复发已得到较好的控制。但目前临床中仍存在两个问题:其一,仍有少数病人出现局部复发,尤其是侧盆壁的复发,多与侧方淋巴结转移相关,而放化疗似乎并不能完全补偿。其二,近年减少放疗应用的研究日渐增多,放疗带来的局部控制优势将有减弱趋势。为减少局部复发,有必要对TME手术范围之外的侧方淋巴结清扫进行探讨。多年来,分别以欧美和日本为代表的双方各执一词,鲜有交融认同,而我国在这方面的研究相对较少,国内同样存在不同的声音。期望未来能够以高质量的研究结果和充分的循证医学证据来准确定义侧方淋巴结清扫的适应证。

With the application of total mesorectal excision and neoadjuvant therapy, local recurrence of rectal cancer has been well controlled. However, there are two problems. Firstly, there are still a small number of patients presented with local recurrence. Of note, the recurrence of the lateral pelvic wall is mostly related to the lymph node metastasis and may not he compensated by radiotherapy or chemotherapy. Secondly, in recent years, research on the reduction of the use of radiotherapy is increasing, which migth compromise the advantage of radiotherapy in local control. In order to reduce local recurrence, it is necessary to discuss the necessity of lateral lymph node dissection beyond the extent of totalmesorectal excision. Over the years, the two sides, represented by Europe and America and Japan, stick to their own words and seldom agree with each other. Rasearch in China is not sufficient to resalve the debate. Therefore, high-quality research and evidence-based medicine are expected to accurately define the indications for lateral lymph node dissection in the future.