直肠癌外科手术切缘中国专家共识(2024版)

Chinese expert consensus for resection margin in rectal cancer surgery(2024 edition)

结直肠癌是我国第二常见的恶性肿瘤,其中直肠癌发生率约占50%。新辅助治疗后,直肠癌根治术仍是诊疗过程中不可或缺的环节。尤其在中低位直肠癌手术中,切缘长度既与预后相关,同时也涉及到器官保留与患者术后生活质量。但如何确定根治术肿瘤远端的“安全”切缘、如何在保证直肠癌根治性切除(R0)的前提下能够最大限度地保留肛门括约肌的功能,是每位外科医生非常关注的重要科学问题。基于此,中华医学会肿瘤学会结直肠肿瘤学组回顾了国内外相关权威指南与文献,将手术切缘相关问题分为直肠癌手术切缘的概念与定义、手术切缘的评估和新辅助治疗后的直肠癌根治术三个章节,形成14条推荐意见,并按照Delphi法由专家组进行两轮投票后形成《直肠癌外科手术切缘中国专家共识(2024版)》,以期为临床医生实施直肠癌根治术提供参考,在不影响患者预后的同时提高患者术后的生活质量。

Colorectal cancer is the second most common malignant tumor in China,with rectal cancer accounting for approximately 50%of all cases.While neoadjuvant therapy is essential for diagnosis and treatment,proctectomy with radical resection remains indispensable.Especially for middle and low rectal cancer,the length of the distal resection margin is critical for prognosis,organ preservation,and postoperative quality of life.However,determining a"safe"margin to ensure the radical resection(R0)while maximizing the function of the anal sphincter poses a significant challenge for surgeons.Aiming at this,we conducted a comprehensive review of authoritative guidelines and literature domestically and internationally.We divided the issues related to resection margin in proctectomy into three chapters:(1)the concept and definition of the resection margin;(2)the evaluation of the resection margin in preoperative,intra-operative,and post-operative stages;and(3)radical resection of rectal cancer after neoadjuvant therapy.With the help of the Delphi method,the expert group voted twice for 14 recommendations and finally established the"Chinese Expert Consensus for Resection Margin in Rectal Cancer Surgery(2024 version)".This consensus serves as a valuable reference for clinicians to carry out proctectomy of rectal cancer,which can improve patient's quality of life without affecting their prognosis.