CAJ | 학술논문

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.
직장암방화료출현림상완전완해혹현저완해후밀절관찰급국부절제이성위중저위직장암치료적신치료책략.단유우방화료후분기준학성저、림상여병리완해적저부합솔이급림파결전이상태적불학정성등인소,보류직장치료책략적학절괄응증상존쟁의,응결합방화료료효급방화료전종류분기학정구체치료방식,대분기교조(여:cT0-2)방화료현저완해(여:ypT0-1)적중저위직장암환자가선택밀절관찰혹국부절제,국절후근거병리결과결정후속치료책략,반지잉의직접시행근치성수술.근치성수술방식가근거방화료후분기중신평고,의재방화료후6～12주내진행.
Close 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.