文献综述(Review)

“等待观察”:直肠癌新辅助放化疗后完全缓解治疗的新策略

Published at: 2017年第26卷第4期

张旋 1 , 程先硕 1 , 余昆 1 , 李云峰 1
1 云南省肿瘤医院/昆明医科大学第三附属医院 结直肠外科/大肠癌临床研究中心,云南 昆明 650118
通讯作者 云峰 李 Email: liyunfeng@medmail.com.cn
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.04.018
基金:

摘要

毋庸置疑,直肠癌尤其是局部进展期直肠癌(LARC)的治疗策略已然发生了翻天覆地的变化。术前新辅助放化疗(NCRT)联合根治性全直肠系膜切除手术(TME)已经成为LARC的金标准治疗模式。NCRT不仅可使肿瘤缩小,降低临床分期,提高手术保肛率,而且使部分患者达到临床甚至病理完全缓解。然而,根治性手术存在手术创伤大,并发症多,以及永久性造瘘带来的痛苦。对于完全缓解的患者是否可以免于外科手术,而采用非手术“等待观察”策略,成为了近年来结直肠外科医师关注的战略问题。笔者就“等待观察”策略的定义、特点、发展史及研究现状等进行综述,并对这一新兴策略的前景提出思考。


"Wait-and-see": a new treatment strategy for rectal cancer with complete response after neoadjuvant chemoradiotherapy

Abstract

Undoubtedly, the treatment strategies for patients with rectal cancer especially for those with locally advanced rectal cancer (LARC) have changed dramatically. Neoadjuvant chemoradiotherapy (NCRT) combined with total mesorectal excision (TME) has been regarded as the gold standard treatment for LARC. NCRT can not only reduce tumor volume, downstage tumor grade and increase sphincter preservation rate, but also allow some patients to achieve a clinical even pathologic complete response. However, the radical surgery may cause great surgical trauma, multiple complications and lifelong suffering of permanent colostomy. So, whether radical surgery can be avoided by instead applying non-surgical “wait-and-see” approach in patients with complete response has become a top-level strategic issue for colorectal surgeons in recent years. Here, the authors address the definition, characteristics, evolution and research status of the “wait-and-see” strategy with some considerations for future prospects of this new strategy.


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引用

引用本文: 旋 张, 先硕 程, 昆 余, 云峰 李. “等待观察”:直肠癌新辅助放化疗后完全缓解治疗的新策略 [J]. 中国普通外科杂志, 2017, 26(4): 514-518.
Cite this article as: ZHANG Xuan, CHENG Xianshuo, YU Kun, LI Yunfeng . "Wait-and-see": a new treatment strategy for rectal cancer with complete response after neoadjuvant chemoradiotherapy[J]. Chin J Gen Surg, 2017, 26(4): 514-518.