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小直肠癌的局部切除后的管理. 完成全腹腔切除术的指示和可能的替代方案

Camélia Labiad¹, Hadrien Alric², Maximilien Barret³

¹Digestive and Oncological Surgery Department, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, université Paris Cité, 20, rue Leblanc, 75015 Paris, France.

Journal of visceral surgery

|March 6, 2024

概括

对于表面直肠癌的治疗有争议. 新的证据表明,单靠粘膜下侵袭深度可能不需要进一步的手术,化疗放射治疗作为pT1直肠癌的潜在替代方案.

科学领域:

胃肠病学胃肠病学
手术瘤学手术瘤学
在瘤学瘤学.

背景情况:

表面直肠癌的治疗方法,包括局部切除与完全中直肠切除 (TME) 的分泌切除,是有争议的.
这些病变的精确分期对于确定适当的治疗策略至关重要.

研究的目的:

评估当前在表面直肠癌治疗中的争议.
评估粘膜下侵袭深度在预测淋巴结转移中的作用.
探索替代性治疗策略,以完成分泌切除术.

主要方法:

使用内镜与虚拟染色内镜和放大镜进行病变深度评估.
审查病理学标准,如分化,淋巴血管入侵和瘤芽.
考虑辅助放射化疗作为完成分泌切除术的替代方案.

主要成果:

内镜技术有助于评估局部切除的可行性.
国际指导方针建议在特定不良的病理条件下进行完整的分泌器切除术.
新出现的数据质疑仅仅依赖下层的侵袭深度来做手术决策.

结论:

粘膜下侵袭的深度可能不是在pT1直肠癌中进行额外的瘤手术的唯一决定因素.
辅助性放射化疗对于被选中的患者来说,是一种可行的替代方案,可以替代完成分泌切除术.
荷兰正在进行一项随机对照试验,以验证这种替代策略.

关键词:

当地切除术 (Local excision) 是一种切除术.放射化疗是一种放射化疗.这是直肠癌.挽救性整形切除术是一种救援性整形切除术.

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