局部进展期直肠癌新辅助治疗后器官保留策略进展

Advances in organ preservation for locally advanced rectal cancer after neoadjuvant chemoradiotherapy

新辅助放化疗联合全直肠系膜切除术为分期T3-T4期或N+的局部进展期直肠癌(LARC)的标准治疗,但往往会带来一系列术后并发症,尤其是接受腹会阴联合直肠癌根治术(Mile's术)不能保留肛门者,严重影响生活质量。对于新辅助治疗后肿瘤(近)临床完全缓解者,器官保留策略在与根治性手术达到相似治疗疗效的同时,可保留肛门及其功能、保证患者的生活质量。本文对LARC新辅助治疗后器官保留策略、联合局部治疗疗效、再生/复发模式及挽救治疗等方面作总结。

Neoadjuvant chemoradiotherapy combined with total mesorectal excision is the standard treatment for stage T3-T4/N+locally advanced rectal cancer(LARC).However,proctectomy is burdened with consistent postoperative morbidity,severely affecting the quality of life.“Organ preserving”methods could achieve similar oncological outcomes in highly selected patients whose tumors demonstrate(almost)clinical complete response to neoadjuvant treatment,while maintaining the quality of life and anorectal function by keeping the anus.This article aims to summarize the strategies of organ preservation after neoadjuvant treatment of LARC,salvage treatment for regrowth or recurrence,and anorectal function after organ preservation strategies.