局部晚期直肠癌盆腔脏器联合切除的难点与挑战

Difficulties and challenges of pelvic exenteration in locally advanced rectal cancer

近年来,随着盆腔肿瘤学和外科技术的进步,外科医生重新定义了盆腔手术的边界。盆腔脏器联合切除术,目前被认为是部分局部晚期和局部复发直肠癌患者的最佳选择。但由于手术复杂,切除范围大,并发症发生率和围手术期病死率较高,所以国内只在少数医院开展。尽管近年来肿瘤药物及外科技术设备有了很大的进步,但作为盆腔脏器联合切除术,对于适应证的选择及其术前评估、新辅助治疗和围手术期治疗策略等方面,仍存在很多争议和挑战。充分认识盆腔脏器的解剖学特征,加强临床多学科团队的密切配合,客观评估以及规范地进行术前综合治疗,积极为复发和复杂局部晚期直肠癌手术根治切除创造条件,同时合理规范地实施R0切除,仍然有可能给局部晚期和复发直肠癌患者带来新的希望。

In recent years,with advances in pelvic oncology and surgical techniques,surgeons have redefined the boundaries of pelvic surgery.Combined pelvic exenteration is now considered the treatment of choice for some patients with locally advanced and locally recurrent rectal cancer,but it is only performed in a few hospitals in China due to the complexity of the procedure and the large extent of resection,complications,and high perioperative mortality.Although there have been great advances in oncologic drugs and surgical techniques and equipment in recent years,there are still many controversies and challenges in the preoperative assessment of combined pelvic organ resection,neoadjuvant treatment selection and perioperative treatment strategies.Adequate understanding of the anatomical features of the pelvic organs,close collaboration of the clinical multidisciplinary team,objective assessment and standardized preoperative combination therapy creates the conditions for radical surgical resection of recurrent and complex locally advanced rectal cancer,while the need for rational and standardized R0 resection still has the potential to bring new hope to patients with locally advanced and recurrent rectal cancer.