摘要直肠癌放化疗出现临床完全缓解或显著缓解后密切观察及局部切除已成为中低位直肠癌治疗的新治疗策略.但由于放化疗后分期准确性低、临床与病理缓解的低符合率以及淋巴结转移状态的不确定性等因素,保留直肠治疗策略的确切适应证尚存争议,应结合放化疗疗效及放化疗前肿瘤分期确定具体治疗方式,对分期较早(如:cT0-2)放化疗显著缓解(如:ypT0-1)的中低位直肠癌患者可选择密切观察或局部切除,局切后根据病理结果决定后续治疗策略,反之仍宜直接施行根治性手术.根治性手术方式可根据放化疗后分期重新评估,宜在放化疗后6～12周内进行.

abstractsClose observation or local excision have developed to be acceptable choices of managing rectal cancer patients who had a complete or major response to neoadjuvant chemoradiation.Indications of these rectumpreserving strategies,however,remain debatable due to inaccurate tumor staging after chemoradiation,apparent discrepancy between pathological and clinical complete responses,and uncertain lymph node status.Both responses to chemoradiation and original tumor staging must be considered to decide the treatment plan.For patients with major response to chemoradiation and with an original staging of cTis-2,a local excision is now acceptable with close postoperative observation or additive radical surgery according to pathological results.Otherwise,a standard radical surgery is still the treatment of choice.Post-radiation tumor evaluation can be employed for decision on sphincter preservation.A longer waiting time of 6-12 weeks before surgery is suggested.