摘要
术前新辅助放化疗(nCRT)联合全直肠系膜切除术是目前局部进展期中低位直肠癌(LARC)的标准治疗模式。nCRT具有良好的降低肿瘤分期作用,且有15%~20%的LARC患者在nCRT后可以获得临床完全缓解(cCR)。鉴于手术潜在的术后并发症以及术后生存质量下降等考量,针对新辅助治疗后获得cCR的患者,有学者提出了等待观察策略(W&W):即不接受手术,定期复查,从而保留器官功能,在不影响患者生存率的前提下提高生存质量。然而,W&W实施过程中出现出了以下问题:(1)应用何种新辅助治疗方案能尽可能地提高cCR率?(2)新辅助治疗后多久作为监测cCR的最佳时间?(3)cCR的正确评估及其与病理完全缓解(pCR)的关系?(4)接受W&W患者长期预后是否能达到同等手术根治效果?(5)W&W患者长期随访困难及可能的复发转移该如何处理?基于此,笔者通过对W&W开展以来的研究状况、cCR面临的争议点及研究方向等方面进行文献综述,为cCR患者的诊治提供一定的参考。
Preoperative neoadjuvant chemoradiotherapy(NCRT)combined with total mesenterectomy is the standard treatment mode for locally advanced rectal cancer(LARC).NCRT has a good efect on reducing tumor stage,and 15%to 20%of LARC patients can obtain clinical complete remission(CCR)after NCRT.In view of the potential postoperative complications and decreased postoperative quality of life,some scholars proposed a watch and wait strategy(W&W)for patients with cCR after neoadjuvant therapy:no surgery,regular review,so as to preserve organ function and improve the quality of lfe without affecting the survival rate.However,the following problems emerged in the implementation of W&W:(1)Which neoadjuvant therapy can improve the cCR rate as much as possible?(2)How long is the best time to define cCR after neoadjuvant therapy?(3)The correct assessment of cCR and its relationship with pathological complete remission(pCR)?(4)Can the long-term prognosis of patients receiving W&W achieve the same effect of radical operation?(5)How to deal with the long-term follow-up difficulties and possible recurrence and metastasis of W&W patients?Based on this,the author made a literature review on the research status of W&W since its launch,the controversial points and research direction of cCR,so as to provide some reference forthe diagnosis and treatment of clinical cCR patients.
作者
郝璐
袁野
余向南
李源
曹阳
陶凯雄
王征
王国斌
Hao Lu;Yuan Ye;Yu Xiangnan;Li Yuan;Cao Yang;Tao Kaixiong;Wang Zheng;Wang Guobin(Department of Gastrointestinal Surgery,Tongji Medical College,Huazhong University of Science and Technology,WuhanHubei Province 430022,China;Research Center for Tissue Engineering and Regenerative Medicine,Tongji Medical College,Huazhong University of Science and Technology,WuhanHubei Province 430022,China;Minimally Invasive Surgery Center,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,WuhanHubei Province 430022,China)
出处
《中华普外科手术学杂志（电子版）》
2022年第5期584-588,共5页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
湖北省技术创新专项重大项目(2018ACA136)。
关键词
直肠肿瘤
新辅助治疗
等待观察策略
临床完全缓解
Rectal neoplasms
Neoadjuvant therapy
Watch and wait
Clinical complete response
