Exploring innovative models of surgical treatment for rectal cancer

Xinxiang LI; Dakui LUO

doi:10.19401/j.cnki.1007-3639.2025.07.001

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Exploring innovative models of surgical treatment for rectal cancer

Specialist's Review | 更新时间：2025-12-31

- Exploring innovative models of surgical treatment for rectal cancer
- China Oncology Vol. 35, Issue 7, Pages: 631-636(2025)
- 作者机构：
  
  复旦大学附属肿瘤医院大肠外二科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
- 基金信息：
  
  National Natural Science Foundation of China(81972260)
- DOI：10.19401/j.cnki.1007-3639.2025.07.001
  CLC： R735.3+7
- Received：01 June 2025，
  
  Revised：2025-07-03，
  
  Published：30 July 2025
- 稿件说明：
移动端阅览
Xinxiang LI, Dakui LUO. Exploring innovative models of surgical treatment for rectal cancer[J]. China Oncology, 2025, 35(7): 631-636.
DOI：

Xinxiang LI, Dakui LUO. Exploring innovative models of surgical treatment for rectal cancer[J]. China Oncology, 2025, 35(7): 631-636. DOI： 10.19401/j.cnki.1007-3639.2025.07.001.

摘要

近年来，直肠癌外科治疗模式发生了深刻变革，治疗目标从单一的肿瘤根治逐渐转向兼顾功能保留，治疗理念也从单纯强调外科技术转向重视综合治疗。特别是在低位直肠癌的治疗中，新辅助治疗模式不断优化，对于新辅助治疗后肿瘤退缩良好的患者，“等待观察”和经肛局部切除成为重要的可选策略。这不仅避免了部分严重的外科治疗相关并发症，也最大程度地保留了患者的器官功能，使患者的生活质量显著提升。这种治疗策略正逐步从局部进展期低位直肠癌向相对早期的低位直肠癌拓展。在外科技术方面，在传统中间入路“先层面后血管”的基础上，提出了“以血管为中心”的入路概念，通过先处理血管再扩展平面的方式，在彻底清扫肠系膜下动脉根部淋巴结的同时保留左结肠动脉。借助双荧光术中导航技术[吲哚菁绿（indocyanine green，ICG）荧光和术中实时成像系统（intraoperative real-time imaging system，IRIS）输尿管荧光显影]，实现了对淋巴结和输尿管的实时显影，既保证了淋巴结清扫的彻底性，也有助于降低输尿管损伤的风险。术中采用的无成角双吻合技术，能够有效地降低吻合口瘘的发生率，提高手术安全性。对于存在吻合口瘘高危因素的患者，肠支架转流术有望替代传统的预防性末端回肠造口术，从而避免预防性末端回肠造口相关的并发症及二次手术回纳造口带来的创伤。总体而言，直肠癌外科治疗的发展趋势是在保证疗效的前提下，最大程度地减少患者创伤、保留器官功能、提高生活质量，推动外科技术向流程化、精准化方向发展，以最大程度地保障患者的围手术期安全。

Abstract

In recent years

the surgical treatment model for rectal cancer has undergone profound changes. The therapeutic goal has gradually shifted from single tumor radical resection to balancing functional preservation

and the therapeutic concept has transformed from merely emphasizing surgical techniques to attaching importance to comprehensive treatment. Especially in the treatment of low rectal cancer

the neoadjuvant therapy model has been continuously optimized. For patients with good tumor regression after neoadjuvant therapy

“watch and wait” and transanal local excision have become important optional strategies. This not only avoids some severe surgery-related complications but also maximizes the preservation of patients’ organ functions

bringing a qualitative leap in their quality of life. This treatment strategy is gradually expanding from locally advanced low rectal cancer to relatively early-stage low rectal cancer. In terms of surgical techniques

based on the traditional intermediate approach of “first plane

then vessels”

the concept of a “vessel-centered” approach is proposed. By managing vessels first and then expanding the plane

it enables thorough dissection of lymph nodes at the root of the inferior mesenteric artery while preserving the left colic artery. With the aid of dual-fluorescence intraoperative navigation technology [indocyanine green (ICG) fluorescence and intraoperative real-time imaging system (IRIS) ureter fluorescence imaging]

real-time visualization of lymph nodes and ureters is achieved

ensuring the completeness of lymph node dissection and helping to reduce the risk of ureteral injury. The angulation-free double anastomosis technique used during surgery effectively reduces the incidence of anastomotic leakage and improves surgical safety. For patients with high-risk factors for anastomotic leakage

intestinal stent bypass is expected to replace the traditional prophylactic end ileostomy

thus avoiding complications associated with prophylactic end ileostomy and the trauma caused by secondary stoma closure. In general

the development trend of surgical treatment for rectal cancer is to minimize patient trauma

preserve organ functions

and improve quality of life under the premise of ensuring oncological efficacy

promoting the development of surgical techniques towards standardization and precision to maximize patients’ perioperative safety.

关键词

Keywords

references

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