局部进展期中低位直肠癌综合治疗焦点问题

Key issues in comprehensive therapy of locally advanced mid-low rectal cancer

新辅助放化疗联合全直肠系膜切除手术已成为局部进展期中低位直肠癌的标准治疗方式。随着综合治疗理念的进步、外科技术的提高,尤其是直肠癌病人对于生存质量要求的提高,免疫治疗、等待观察策略以及经肛全直肠系膜切除手术等,逐渐成为进展期中低位直肠癌治疗领域的焦点问题。基于这些新理念、新方法、新技术的临床研究和实践,越来越多的局部进展期中低位直肠癌病人通过术前治疗达到肿瘤学降期甚至肿瘤完全缓解,保留直肠而免于手术、根治性保肛手术的机会。进一步推动了局部进展期中低位直肠癌诊疗模式向个体化、精准化方向发展。

The combination of neoadjuvant chemotherapy and total mesorectal excision(TME)has become the standard treatment for locally advanced mid-low rectal cancer.Along with the progress in the concept of multimodality therapy,the improvement in surgical techniques,and especially the upgradation in patients’requirement for survival quality,transanal total mesorectal excision(taTME),optimization of neoadjuvant immunotherapy,and watch and wait strategy have gradually become the key issues in synthetic therapy for locally advanced mid-low rectal cancer.Based on these new concepts,methods,and technologies in clinical research and practice,an increasing number of locally advanced mid-low rectal cancer patients achieve oncological regression or even complete tumor remission through preoperative treatment and obtain the opportunity to preserve the rectum without surgery or receive curative anal preservation surgery,further promoting the development of individualized and precise diagnosis and treatment models for locally advanced mid-low rectal cancer.