摘要
全盆腔脏器切除术(TPE)被广泛认为是原发性局部进展期直肠癌和局部复发直肠癌最有效的治疗手段。然而,TPE也同时面临诸多挑战,包括可能无法实现R 0切除、并发症发生率高、术后生活质量下降以及可能存在对无癌性粘连、炎性粘连或新辅助治疗后病理完全缓解患者的过度治疗。在精准医疗时代,如何提高术前直肠外癌侵犯的精确诊断,充分应用基因分子分型方法和新型新辅助治疗策略,进一步提高TPE的R 0切除率,降低手术并发症发生率和病死率,改善患者术后生活质量,并在根治性切除与器官功能保护之间达到最佳平衡,值得进一步研究。
Total pelvic exenteration(TPE)is widely regarded as the most effective intervention for the management of primary locally advanced rectal cancer and locally recurrent rectal cancer.However,TPE presents several challenges,including the potential for failing to achieve R0 resection,high incidence of complication,decreased postoperative quality of life,and the possible overtreatment in patients without carcinomatous adhesions or with only inflammatory adhesions,as well as in those who achieve pathological complete response after neoadjuvant therapy.In the context of precision medicine,further investigation is necessary to enhance the accuracy of preoperative diagnoses of extrarectal cancer invasion and to explore the comprehensive application of genetic molecular typing methods alongside innovative neoadjuvant treatment strategies.Such research should aim to enhance the R0 resection rate of TPE,minimize surgical complications and mortality,improve postoperative quality of life,and achieve an optimal balance between radical resection and the preservation of organ function.
作者
蒋伟忠
池畔
Jiang Weizhong;Chi Pan(Department of General Surgery&Colorectal Surgery,Union Hospital,Fujian Medical University,Fuzhou 350001,China)
出处
《中华胃肠外科杂志》
北大核心
2025年第7期717-724,共8页
Chinese Journal of Gastrointestinal Surgery
基金
福建省微创医学中心建设项目(闽卫医政[2021]76号)
福建省科技创新联合资金(2024Y9290)。
关键词
直肠肿瘤
全盆腔脏器切除术
全程新辅助治疗
精准医学
器官保留
Rectal neoplasms
Total pelvic exenteration
Total neoadjuvant therapy
Precision medicine
Organpreservation
