摘要
术前同期放化疗、根治性手术及术后化疗相结合的“三明治”模式是指南推荐的低位局部进展期直肠癌(locally advanced rectal cancer,LARC)的标准治疗方案。然而,这种模式在带来一定疗效的同时,也暴露出诸多问题,其中根治性手术导致的肛门功能障碍及器官毁损尤为突出。如何在确保新辅助治疗疗效的同时尽可能保留器官功能,已成为LARC临床实践亟待解决的关键问题。随着全身治疗水平的不断提升和局部治疗技术的全面革新,越来越多低位LARC患者不仅获得了满意疗效,也实现了器官功能的保留。本文旨在针对近年来新辅助全身治疗方案的优化、放疗模式的改进、微创手术治疗的革新,以及临床完全缓解等待观察策略的进展等多学科领域对LARC保肛治疗的推动作用展开述评,为目前的临床实践提供参考。
Currently,the“sandwich”approach—combining preoperative concurrent chemoradiotherapy,radical surgery,and postoperative chemotherapy—is widely recognized as the standard therapeutic regimen for low-lying locally advanced rectal cancer(LARC).Nevertheless,despite its notable efficacy,this strategy also presents several challenges,among which anal dysfunction and organ impairment caused by radical surgery are particularly prominent.How to maximize organ preservation while ensuring the effectiveness of neoadjuvant treatment has thus become a critical issue in LARC clinical practice.With continuous improvements in systemic therapies and significant innovations in local treatment techniques,an increasing number of patients with low-lying LARC are achieving both satisfactory oncological outcomes and organ preservation.This article aims to provide a comprehensive review of the advancements in multidisciplinary fields that have contributed to the promotion of organ-preserving treatment for LARC.These advancements include the optimization of neoadjuvant systemic therapy regimens,improvements in radiotherapy techniques,innovations in minimally invasive surgical procedures,and the progress in watch-and-wait strategies following clinical complete response,providing a reference for current clinical practice.
作者
彭健宏
王炜锋
王若蔚
司徒颖婷
周驰
李伟豪
王淞
廖元彬
林俊忠
Peng Jianhong;Wang Weifeng;Wang Ruowei;Situ Yingting;Zhou Chi;Li Weihao;Wang Song;Liao Yuanbin;Lin Junzhong(Department of Colorectal Surgery,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Guangdong Clinical Research Center for Cancer,Guangzhou 510060,Guangdong,China;School of Renji Clinical Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)
出处
《消化肿瘤杂志(电子版)》
2025年第2期168-181,共14页
Journal of Digestive Oncology(Electronic Version)
基金
广东省自然科学基金(2023A1515010417)
广州市科技计划项目(2023A04J1078)
希思科肿瘤研究基金项目(Y-Young20220023
Y-Gilead2024-PT-0006)。
关键词
直肠癌
新辅助治疗
多学科
器官功能保全
Rectal Cancer
Neoadjuvant treatment
Multidisciplinary
Organ preservation
