局部进展期直肠癌的手术时机把握

Optimal timing of surgery for locally advance rectal cancer:how we choose

局部进展期直肠癌(LARC)术后具有较高的局部复发率和远处转移率,仅靠手术难以达到有效治疗。新辅助放化疗联合根治性手术是其标准治疗,可明显降低LARC的局部复发率,但却显著危害病人肛门和泌尿生殖功能,严重影响生活质量。因此如何避免目前“一刀切”的治疗模式,选择最佳的根治性手术时机,使其兼顾肿瘤学预后和生活质量是目前的研究热点和难点。笔者认为通过术前评估LARC风险,合理选择根治性手术时机是目前行之有效的策略:对术前风险评估为中低危的病人可考虑直接手术,或术前化疗联合根治性手术;对于高危病人,可通过加强术前新辅助治疗等策略,延后根治性手术时机,以改善肿瘤学预后。本文围绕LARC根治性的时机选择进行分析讨论,为后续LARC开展个体化和精细化的治疗选择提供思路。

Locally advanced rectal cancer(LARC) is associated with a high risk of local recurrence and distant metastasis,making it difficult to be cured by surgery alone.Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for LARC,with reduced local recurrence rates.However,neoadjuvant chemoradiotherapy is associated with patients′ urogenital and sexual dysfunction,which severely affecting their quality of life.Therefore,determining the optimal timing of surgery to balance oncologic and functional outcomes is crucial and challenging.We proposed that choosing the optimal timing of surgery based on preoperative risk assessment of LARC is an effective strategy.The patients with low to moderate risk of recurrence can be considered to perform surgery directly or have preoperative chemotherapy followed by radical surgery.Patients with high risk of recurrence should extend neoadjuvant therapy before surgery to improve oncologic outcomes.In this study we explored the optimal timing of radical surgery for LARC,providing a new idea for individualized and precise treatment of LARC.