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Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

World Journal of Gastrointestinal surgery 2017年第6期9卷 139-148页

作者： Joseph M Plummer Pierre-Anthony Leake Matthew R Albert Department of surgery Radiology Anaesthesia and Intensive Care University of the West Indies Center for Colon and Rectal surgery De-partment of Colon and Rectal Surgery Florida Hospital

Over the last decade,with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer,there has been a significant increase in the literature regarding treatment options available to patients affected by this *** treatment related decisions should be made at a high volume multidisciplinary tumor board,after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision(TME)are accepted standard of *** controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders,which may be appropriate in 20%of *** with early T1 rectal cancers and favorable pathologic features can be cured with local excision only,with transanal minimal invasive surgery(TAMIS)because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon,emerging as the leading *** trials have raised concerns about the oncologic outcomes of the standard"top-down"TME hence transanal TME(Ta TME"bottom-up")approach has gained popularity as an *** challenges are many,with a dearth of evidence of the oncologic superiority in the long-term for any given ***,this review highlights recent advances in the role of chemoradiation only for complete pathologic responders,TAMIS for highly selected early rectal cancer patients and Ta TME as options to improve cure rates whilst maintaining quality of life in these patients,while we await the results of further definitive trials being currently conducted.

关键词： Rectal cancer Watchful waiting transanal minimal invasive surgery transanal total mesorectal excision

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