Make efforts to elevate the level of surgical treatment of rectal cancer
- VernacularTitle:努力提高直肠癌外科治疗水平
- Author:
Shiyong LI
- Publication Type:Journal Article
- Keywords:
rectal neoplasms;
digestive system surgical procedures;
treatment outcome
- From:
Medical Journal of Chinese People's Liberation Army
2001;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
With a comprehensive elaboration of the development of the level of surgical treatment of the rectal cancer, with a preliminarily analysis of the related questions in the surgery, it is the assertion of the author that early discovery, diagnosis and treatment are the key points in raising the five-year survival rate. Constant surveillance in the region of prevalence, constant survey and close inspection of high risk groups are much more important to detect early stage cancers in time. Diagnostic rates can reach 95%-100% by fibercoloscope, barium enema, B-ultrasound and CT, etc. About 70% of rectal cancers situated at middle and desending colon can be found by anal palpation. It is important to select correct and appropriate operative modality to raise the treatment efficacy. We should follow the TME principle to select which sphincter-preserving operation should be done: Parks operation, anastomat operation, peritoneoscope operation, autonomic nerve of pelvic cavity preservation operation, or LSY operation, etc. So that not only a radical cure of the tumor is ensured, also the lymph nodes are removed, and to ensure to preserve the normal defecation function. Thus, we should individualize operation according to the site, biological character, and clinical stages. Sphincter-preserving operation accounts for above 70% of resection of rectal cancer, and its local recurrence and five-year survival rate is similar to that of Mile′s operation, but the patient′s life quality is obviously raised. Recently, phincter-preserving operation has been the first choice for resection of the rectal cancer. The author emphasizes that the combined therapy to local recurrence and metastasis is important to raise five-year survival rate. Operation only is insufficient, we should pay attention to combined therapy, such as pro-operative chemotherapy, radiotherapy and immunotherapy. We should pay more attention to detecting, diagnosing and treating the local recurrence and metastasis in early stage after operation, and resect them aggressively. When they cannot be resected, give chemotherapy and radiotherapy first, when it shrinks, it can be resected again. The five-year survival rate can reach 40%. As it is difficult to resect the liver metastasis, so when the primary cancer does not recur, liver transplantation is the first choice. Obvionsly, to raise the rate of a prolonged survival, combined therapy including chemotherapy, radiotherapy, immunotherapy and biotherapy should be instituted besides surgical excision.
