新辅助放疗联合免疫治疗对直肠癌微创术式应用的影响

Influence of neoadjuvant radiotherapy combined with immunotherapy on minimally invasive surgeries for rectal cancer

对于中、低位进展期直肠癌,目前的国内、外指南均推荐先行新辅助放、化疗或全程新辅助治疗后再行根治性手术。近年来,免疫检查点抑制剂对于相应敏感的微卫星高度不稳定/错配修复缺陷直肠肿瘤病人的显著疗效已得到公认。最新的研究报道显示,在微卫星稳定/错配修复正常的直肠癌新辅助治疗中,将免疫检查点抑制剂与放疗结合,亦可获得显著的肿瘤退缩,有望开启直肠癌新辅助治疗的全新时代。即便如此,手术仍是当前直肠癌多学科诊疗模式中的中心环节。但可以预见的是,更为显著的术前肿瘤退缩将会极大地促进直肠癌微创术式的广泛开展。以经肛门内镜显微手术、经肛全直肠系膜切除术、腹腔镜全直肠系膜切除术+经自然腔道标本取出手术为代表的直肠癌微创术式有望得到进一步推广,成为直肠癌放疗联合免疫治疗时代的标准术式。

The current domestic and international guidelines recommend neoadjuvant chemoradiation or totalneoadjuvant therapy followed by radical surgery for mid-low locally advanced rectal cancer.In recent years,the signifi-cant efficacy of immune checkpoint inhibitors has been recognized for patients with microsatellite instability-high/mis-match repair deficiency.The latest researchs show that in the neoadjuvant therapy of microsatellite stability/mismatchrepair proficient rectal cancers,combining immune checkpoint inhibitors with radiotherapy can also achieve signifi-cant tumor regression,which is expected to usher in a new era of neoadjuvant therapy for rectal cancer.Even so,sur-gery remains pivotal in the current multidisciplinary diagnosis and treatment modelity for rectal cancer.However,itcan be foreseen that a more significant preoperative tumor regression will greatly promote the widespread use of mini-mally invasive surgery.The minimally invasive surgery for rectal cancer represented by transanal endoscopic microsur-gery,transanal total mesorectal excision,laparoscopic total mesorectal excision plus removal of specimens throughnatural cavity is hopeful to be further promoted and become the standard surgery in the era of radiotherapy combinedwith immunotherapy for rectal cancer.