低位直腸癌保肛手術的再認識_《中國普外基礎與臨床雜志》

作者：

汪建平

中山大學附屬第六醫院，廣東省胃腸肛門醫院結直腸外科（廣東廣州 510655）;

關鍵詞：

低位直腸癌保肛手術全直腸系膜切除新輔助治療

視頻：

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引用本文： 汪建平. 低位直腸癌保肛手術的再認識. 中國普外基礎與臨床雜志, 2012, 19(6): 577-582. doi: 復制

1.	鄭榮壽，張思維，吳良有，等. 中國腫瘤登記地區2008 年惡性腫瘤發病和死亡分析 [J]. 中國腫瘤， 2012， 21(1)：1-12.
2.	Heald RJ， Husband EM， Ryall RD. The mesorectum in rectal cancer surgery—— the clue to pelvic recurrence? [J]. Br J Surg，1982， 69(10)：613-616.
3.	Freeny PC， Marks WM， Ryan JA， et al. Colorectal carcinoma evaluation with CT：preoperative staging and detection of postoperative recurrence [J]. Radiology， 1986， 158(2)：347-353.
4.	Kim NK， Kim MJ， Yun SH， et al. Comparative study of transrectal ultrasonography， pelvic computerized tomography， and magnetic resonance imaging in preoperative staging of rectal cancer [J]. Dis Colon Rectum， 1999， 42(6)：770-775.
5.	Leufkens AM， van den Bosch MA， van Leeuwen MS， et al. Diagnostic accuracy of computed tomography for colon cancer staging：a systematic review [J]. Scand J Gastroenterol， 2011， 46(7-8)：887-894.
6.	Skandarajah AR， Tjandra JJ. Preoperative loco-regional imaging in rectal cancer [J]. ANZ J Surg， 2006， 76(6)：497-504.
7.	Beets-Tan RG， Beets GL. Rectal cancer：how accurate can imaging predict the T stage and the circumferential resection margin?[J]. Int J Colorectal Dis， 2003， 18(5)：385-391.
8.	Martling A， Holm T， Rutqvist LE， et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm [J].Br J Surg， 2005， 92(2)：225-229.
9.	Enker WE. Total mesorectal excision——the new golden standard of surgery for rectal cancer [J]. Ann Med， 1997， 29(2)：127-133.
10.	Clausen N， Wolloscheck T， Konerding MA. How to optimize autonomic nerve preservation in total mesorectal excision：clinical topography and morphology of pelvic nerves and fasciae [J].World J Surg， 2008， 32(8)：1768-1775.
11.	Shirouzu K， Isomoto H， Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery [J]. Cancer， 1995， 76(3)：388-392.
12.	Guillem JG， Chessin DB， Shia J， et al. A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy：implications for sphincter preservation [J]. Ann Surg， 2007， 245(1)：88-93.
13.	Kiran RP， Lian L， Lavery IC. Does a subcentimeter distal resection margin adversely influence oncologic outcomes in patients with rectal cancer undergoing restorative proctectomy? [J]. Dis Colon Rectum， 2011， 54(2)：157-163.
14.	Cawthorn SJ， Parums DV， Gibbs NM， et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer [J]. Lancet， 1990， 335(8697)：1055-1059.
15.	Scott N， Jackson P， al-Jaberi T， et al. Total mesorectal excision and local recurrence：a study of tumour spread in the mesorectum distal to rectal cancer [J]. Br J Surg， 1995， 82(8)：1031-1033.
16.	Zhao GP， Zhou ZG， Lei WZ， et al. Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin [J]. World J Gastroenterol， 2005， 11(3)：319-322.
17.	Quirke P， Steele R， Monson J， et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer：a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial [J]. Lancet， 2009，373(9666)：821-828.
18.	Nagtegaal ID， Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? [J]. J Clin Oncol， 2008， 26(2)：303-312.
19.	Wallace MH， Glynne-Jones R. Saving sphincter in rectal cancer：are we prepared to change practice? [J]. Colorectal Dis， 2007，9(4)：302-309.
20.	Schiessel R， Karner-Hanusch J， Herbst F， et al. Intersphincteric resection for low rectal tumours [J]. Br J Surg， 1994， 81(9)：1376-1378.
21.	Tiret E， Poupardin B， McNamara D， et al. Ultralow anterior resection with intersphincteric dissection——what is the limit of safe sphincter preservation? [J]. Colorectal Dis， 2003， 5(5)：454-457.
22.	Rullier E， Laurent C， Bretagnol F， et al. Sphincter-saving resection for all rectal carcinomas：the end of the 2-cm distal rule [J].Ann Surg， 2005， 241(3)：465-469.
23.	Martin ST， Heneghan HM， Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer [J]. Br J Surg， 2012， 99(5)：603-612.
24.	Williams NS， Murphy J， Knowles CH. Anterior perineal plane for ultra-low anterior resection of the rectum (the APPEAR technique)：a prospective clinical trial of a new procedure [J]. Ann Surg， 2008， 247(5)：750-758.
25.	李明，于泉波，趙輝，等. 經會陰平面超低位直腸前切除術治療低位直腸癌39 例 [J]. 世界華人消化雜志， 2012， 20(10)：888-890.
26.	Morson BC， Busse HJ， Samoorian S. Policy of local excision for early cancer of the rectum [J]. Gut， 1977， 18(12)：1045-1050.
27.	衛生部醫政司. 結直腸癌診療規范(2010 年版) [J]. 中國醫學前沿雜志( 電子版)， 2011， 3(6)：130-146.
28.	Buess G， Hutterer F， Theiss J， et al. A system for a transanal endoscopic rectum operation [J]. Chirurg， 1984， 55(10)：677-680.
29.	Lezoche G， Guerrieri M， Baldarelli M， et al. Transanal endoscopic microsurgery for 135 patients with small nonadvanced low rectal cancer (iT1-iT2， iN0)：short- and long-term results [J].Surg Endosc， 2011， 25(4)：1222-1229.
30.	Kusunoki M， Shoji Y， Yanagi H， et al. Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis [J]. Br J Surg， 1991， 78(12)：1434-1438.
31.	Hida J， Yasutomi M， Fujimoto K， et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size [J]. Dis Colon Rectum，1996， 39(9)：986-991.
32.	Z’graggen K， Maurer CA， Buchler MW. Transverse coloplasty pouch. A novel neorectal reservoir [J]. Dig Surg， 1999， 16(5)：363-366.
33.	Heriot AG， Tekkis PP， Constantinides V， et al. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection [J]. Br J Surg， 2006， 93(1)：19-32.
34.	Ptok H， Marusch F， Meyer F， et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection [J]. Br J Surg， 2007， 94(12)：1548-1554.
35.	Gastinger I， Marusch F， Steinert R， et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma [J]. Br J Surg， 2005， 92(9)：1137-1142.
36.	Hüser N， Michalski CW， Erkan M， et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery [J]. Ann Surg， 2008， 248(1)：52-60.
37.	Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med， 2004， 350(20)：2050-2059.
38.	Guillou PJ， Quirke P， Thorpe H， et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial)：multicentre， randomised controlled trial [J]. Lancet， 2005， 365(9472)：1718-1726.
39.	Fleshman J， Sargent DJ， Green E， et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial [J]. Ann Surg， 2007， 246(4)：655-662.
40.	Lujan J， Valero G， Hernandez Q， et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer [J]. Br J Surg， 2009， 96(9)：982-989.
41.	Park JS， Choi GS， Jun SH， et al. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer：intermediate-term oncologic outcomes [J]. Ann Surg，2011， 254(6)：941-946.
42.	Memon S， Heriot AG， Murphy DG， et al. Robotic versus laparoscopic proctectomy for rectal cancer：a Meta-analysis [J]. Ann Surg Oncol， 2012 Feb 16.[ Epub ahead of print].
43.	Leong QM， Son DN， Cho JS， et al. Robot-assisted intersphincteric resection for low rectal cancer：technique and short-term outcome for 29 consecutive patients [J]. Surg Endosc， 2011，25(9)：2987-2992.
44.	Akmal Y， Baek JH， McKenzie S， et al. Robot-assisted total mesorectal excision：is there a learning curve? [J]. Surg Endosc，2012 Mar 22.[ Epub ahead of print].
45.	Martling A， Holm T， Johansson H， et al. The Stockholm Ⅱ trial on preoperative radiotherapy in rectal carcinoma：long-term follow-up of a population-based study [J]. Cancer， 2001， 92(4)：896-902.
46.	Bujko K， Nowacki MP， Oledzki J， et al. Sphincter preservation after short-term preoperative radiotherapy for low rectal cancer：presentation of own data and a literature review [J]. Acta Oncol，2001， 40(5)：593-601.
47.	Stephens RJ， Thompson LC， Quirke P， et al. Impact of shortcourse preoperative radiotherapy for rectal cancer on patients’quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial [J]. J Clin Oncol， 2010， 28(27)：4233-4239.
48.	Swedish Rectal cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer [J]. N Engl J Med，1997， 336(14)：980-987.
49.	Peeters KC， Marijnen CA， Nagtegaal ID， et al. The TME trial after a median follow-up of 6 years：increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma [J]. Ann Surg， 2007， 246(5)：693-701.
50.	Rullier E， Goffre B， Bonnel C， et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum [J]. Ann Surg， 2001， 234(5)：633-640.
51.	Gerard JP， Rostom Y， Gal J， et al. Can we increase the chance of sphincter saving surgery in rectal cancer with neoadjuvant treatments lessons from a systematic review of recent randomized trials [J]. Crit Rev Oncol Hematol， 2012， 81(1)：21-28. Epub 2011 Mar 5.
52.	Bosset JF， Calais G， Mineur L， et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results——EORTC 22921 [J]. J Clin Oncol，2005， 23(24)：5620-5627.
53.	Rödel C， Martus P， Papadoupolos T， et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer [J]. J Clin Oncol， 2005， 23(34)：8688-8696.
54.	Sauer R， Becker H， Hohenberger W， et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer [J]. N Engl J Med， 2004， 351(17)：1731-1740.
55.	Roh MS， Colangelo LH， O’Connell MJ， et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum：NSABP R?03 [J]. J Clin Oncol，2009， 27(31)：5124-5130.

1. 鄭榮壽，張思維，吳良有，等. 中國腫瘤登記地區2008 年惡性腫瘤發病和死亡分析 [J]. 中國腫瘤， 2012， 21(1)：1-12.
2. Heald RJ， Husband EM， Ryall RD. The mesorectum in rectal cancer surgery—— the clue to pelvic recurrence? [J]. Br J Surg，1982， 69(10)：613-616.
3. Freeny PC， Marks WM， Ryan JA， et al. Colorectal carcinoma evaluation with CT：preoperative staging and detection of postoperative recurrence [J]. Radiology， 1986， 158(2)：347-353.
4. Kim NK， Kim MJ， Yun SH， et al. Comparative study of transrectal ultrasonography， pelvic computerized tomography， and magnetic resonance imaging in preoperative staging of rectal cancer [J]. Dis Colon Rectum， 1999， 42(6)：770-775.
5. Leufkens AM， van den Bosch MA， van Leeuwen MS， et al. Diagnostic accuracy of computed tomography for colon cancer staging：a systematic review [J]. Scand J Gastroenterol， 2011， 46(7-8)：887-894.
6. Skandarajah AR， Tjandra JJ. Preoperative loco-regional imaging in rectal cancer [J]. ANZ J Surg， 2006， 76(6)：497-504.
7. Beets-Tan RG， Beets GL. Rectal cancer：how accurate can imaging predict the T stage and the circumferential resection margin?[J]. Int J Colorectal Dis， 2003， 18(5)：385-391.
8. Martling A， Holm T， Rutqvist LE， et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm [J].Br J Surg， 2005， 92(2)：225-229.
9. Enker WE. Total mesorectal excision——the new golden standard of surgery for rectal cancer [J]. Ann Med， 1997， 29(2)：127-133.
10. Clausen N， Wolloscheck T， Konerding MA. How to optimize autonomic nerve preservation in total mesorectal excision：clinical topography and morphology of pelvic nerves and fasciae [J].World J Surg， 2008， 32(8)：1768-1775.
11. Shirouzu K， Isomoto H， Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery [J]. Cancer， 1995， 76(3)：388-392.
12. Guillem JG， Chessin DB， Shia J， et al. A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy：implications for sphincter preservation [J]. Ann Surg， 2007， 245(1)：88-93.
13. Kiran RP， Lian L， Lavery IC. Does a subcentimeter distal resection margin adversely influence oncologic outcomes in patients with rectal cancer undergoing restorative proctectomy? [J]. Dis Colon Rectum， 2011， 54(2)：157-163.
14. Cawthorn SJ， Parums DV， Gibbs NM， et al. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer [J]. Lancet， 1990， 335(8697)：1055-1059.
15. Scott N， Jackson P， al-Jaberi T， et al. Total mesorectal excision and local recurrence：a study of tumour spread in the mesorectum distal to rectal cancer [J]. Br J Surg， 1995， 82(8)：1031-1033.
16. Zhao GP， Zhou ZG， Lei WZ， et al. Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin [J]. World J Gastroenterol， 2005， 11(3)：319-322.
17. Quirke P， Steele R， Monson J， et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer：a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial [J]. Lancet， 2009，373(9666)：821-828.
18. Nagtegaal ID， Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? [J]. J Clin Oncol， 2008， 26(2)：303-312.
19. Wallace MH， Glynne-Jones R. Saving sphincter in rectal cancer：are we prepared to change practice? [J]. Colorectal Dis， 2007，9(4)：302-309.
20. Schiessel R， Karner-Hanusch J， Herbst F， et al. Intersphincteric resection for low rectal tumours [J]. Br J Surg， 1994， 81(9)：1376-1378.
21. Tiret E， Poupardin B， McNamara D， et al. Ultralow anterior resection with intersphincteric dissection——what is the limit of safe sphincter preservation? [J]. Colorectal Dis， 2003， 5(5)：454-457.
22. Rullier E， Laurent C， Bretagnol F， et al. Sphincter-saving resection for all rectal carcinomas：the end of the 2-cm distal rule [J].Ann Surg， 2005， 241(3)：465-469.
23. Martin ST， Heneghan HM， Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer [J]. Br J Surg， 2012， 99(5)：603-612.
24. Williams NS， Murphy J， Knowles CH. Anterior perineal plane for ultra-low anterior resection of the rectum (the APPEAR technique)：a prospective clinical trial of a new procedure [J]. Ann Surg， 2008， 247(5)：750-758.
25. 李明，于泉波，趙輝，等. 經會陰平面超低位直腸前切除術治療低位直腸癌39 例 [J]. 世界華人消化雜志， 2012， 20(10)：888-890.
26. Morson BC， Busse HJ， Samoorian S. Policy of local excision for early cancer of the rectum [J]. Gut， 1977， 18(12)：1045-1050.
27. 衛生部醫政司. 結直腸癌診療規范(2010 年版) [J]. 中國醫學前沿雜志( 電子版)， 2011， 3(6)：130-146.
28. Buess G， Hutterer F， Theiss J， et al. A system for a transanal endoscopic rectum operation [J]. Chirurg， 1984， 55(10)：677-680.
29. Lezoche G， Guerrieri M， Baldarelli M， et al. Transanal endoscopic microsurgery for 135 patients with small nonadvanced low rectal cancer (iT1-iT2， iN0)：short- and long-term results [J].Surg Endosc， 2011， 25(4)：1222-1229.
30. Kusunoki M， Shoji Y， Yanagi H， et al. Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis [J]. Br J Surg， 1991， 78(12)：1434-1438.
31. Hida J， Yasutomi M， Fujimoto K， et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size [J]. Dis Colon Rectum，1996， 39(9)：986-991.
32. Z’graggen K， Maurer CA， Buchler MW. Transverse coloplasty pouch. A novel neorectal reservoir [J]. Dig Surg， 1999， 16(5)：363-366.
33. Heriot AG， Tekkis PP， Constantinides V， et al. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection [J]. Br J Surg， 2006， 93(1)：19-32.
34. Ptok H， Marusch F， Meyer F， et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection [J]. Br J Surg， 2007， 94(12)：1548-1554.
35. Gastinger I， Marusch F， Steinert R， et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma [J]. Br J Surg， 2005， 92(9)：1137-1142.
36. Hüser N， Michalski CW， Erkan M， et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery [J]. Ann Surg， 2008， 248(1)：52-60.
37. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med， 2004， 350(20)：2050-2059.
38. Guillou PJ， Quirke P， Thorpe H， et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial)：multicentre， randomised controlled trial [J]. Lancet， 2005， 365(9472)：1718-1726.
39. Fleshman J， Sargent DJ， Green E， et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial [J]. Ann Surg， 2007， 246(4)：655-662.
40. Lujan J， Valero G， Hernandez Q， et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer [J]. Br J Surg， 2009， 96(9)：982-989.
41. Park JS， Choi GS， Jun SH， et al. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer：intermediate-term oncologic outcomes [J]. Ann Surg，2011， 254(6)：941-946.
42. Memon S， Heriot AG， Murphy DG， et al. Robotic versus laparoscopic proctectomy for rectal cancer：a Meta-analysis [J]. Ann Surg Oncol， 2012 Feb 16.[ Epub ahead of print].
43. Leong QM， Son DN， Cho JS， et al. Robot-assisted intersphincteric resection for low rectal cancer：technique and short-term outcome for 29 consecutive patients [J]. Surg Endosc， 2011，25(9)：2987-2992.
44. Akmal Y， Baek JH， McKenzie S， et al. Robot-assisted total mesorectal excision：is there a learning curve? [J]. Surg Endosc，2012 Mar 22.[ Epub ahead of print].
45. Martling A， Holm T， Johansson H， et al. The Stockholm Ⅱ trial on preoperative radiotherapy in rectal carcinoma：long-term follow-up of a population-based study [J]. Cancer， 2001， 92(4)：896-902.
46. Bujko K， Nowacki MP， Oledzki J， et al. Sphincter preservation after short-term preoperative radiotherapy for low rectal cancer：presentation of own data and a literature review [J]. Acta Oncol，2001， 40(5)：593-601.
47. Stephens RJ， Thompson LC， Quirke P， et al. Impact of shortcourse preoperative radiotherapy for rectal cancer on patients’quality of life：data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial [J]. J Clin Oncol， 2010， 28(27)：4233-4239.
48. Swedish Rectal cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer [J]. N Engl J Med，1997， 336(14)：980-987.
49. Peeters KC， Marijnen CA， Nagtegaal ID， et al. The TME trial after a median follow-up of 6 years：increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma [J]. Ann Surg， 2007， 246(5)：693-701.
50. Rullier E， Goffre B， Bonnel C， et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum [J]. Ann Surg， 2001， 234(5)：633-640.
51. Gerard JP， Rostom Y， Gal J， et al. Can we increase the chance of sphincter saving surgery in rectal cancer with neoadjuvant treatments lessons from a systematic review of recent randomized trials [J]. Crit Rev Oncol Hematol， 2012， 81(1)：21-28. Epub 2011 Mar 5.
52. Bosset JF， Calais G， Mineur L， et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer：preliminary results——EORTC 22921 [J]. J Clin Oncol，2005， 23(24)：5620-5627.
53. Rödel C， Martus P， Papadoupolos T， et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer [J]. J Clin Oncol， 2005， 23(34)：8688-8696.
54. Sauer R， Becker H， Hohenberger W， et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer [J]. N Engl J Med， 2004， 351(17)：1731-1740.
55. Roh MS， Colangelo LH， O’Connell MJ， et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum：NSABP R?03 [J]. J Clin Oncol，2009， 27(31)：5124-5130.

《中國普外基礎與臨床雜志》

低位直腸癌保肛手術的再認識

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

《中國普外基礎與臨床雜志》

低位直腸癌保肛手術的再認識

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料