PDF(Pubmed)
Abstract：
The introduction of total mesorectal excision into the radical surgery of rectal cancer has significantly improved the oncological outcome with longer survival and lower local recurrence. Traditional treatment modalities of distal rectal cancer, relying on radical surgery, while effective, take their own set of risks, including surgical complications, potential damage to the anus, and surrounding structure owing to the pursuit of thorough resection. The progress of operating methods as well as the integration of systemic therapies and radiotherapy into the peri-operative period, particularly the exciting clinical complete response of patients after neoadjuvant treatment, have paved the way for organ preservation strategy. The non-inferiority oncological outcome of \"watch and wait\" compared with radical surgery underscores the potential of organ preservation not only to control local recurrence but also to reduce the need for treatments followed by structure destruction, hopefully improving the long-term quality of life. Radical radiotherapy provides another treatment option for patients unwilling or unable to undergo surgery. Organ preservation points out the direction of treatment for distal rectal cancer, while additional researches are needed to answer remaining questions about its optimal use.
摘要：
■在直肠癌根治性手术中引入全直肠系膜切除术显著改善了肿瘤预后，具有更长的生存期和更低的局部复发率。远端直肠癌的传统治疗方式，依靠根治性手术，虽然有效，承担自己的风险，包括手术并发症,对肛门的潜在损害,和周围的结构，由于追求彻底切除。手术方法的进展以及将全身治疗和放射治疗整合到围手术期，特别是新辅助治疗后患者令人兴奋的临床完全反应，为器官保存策略铺平了道路。与根治性手术相比，“观察和等待”的非劣效性肿瘤结果强调了器官保存的潜力，不仅可以控制局部复发，而且可以减少对结构破坏的治疗需求。希望能改善长期的生活质量.根治性放疗为不愿意或不能接受手术的患者提供了另一种治疗选择。器官保存为远端直肠癌的治疗指明了方向,而需要更多的研究来回答关于其最佳使用的剩余问题。
