直肠癌外科治疗的创新模式探讨

李心翔; 骆大葵

doi:10.19401/j.cnki.1007-3639.2025.07.001

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直肠癌外科治疗的创新模式探讨

专家述评 | 更新时间：2025-12-31

- 直肠癌外科治疗的创新模式探讨
- Exploring innovative models of surgical treatment for rectal cancer
- 中国癌症杂志 2025年35卷第7期页码：631-636
- 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：
  
  [ "李心翔，复旦大学附属肿瘤医院大肠外二科主任，主任医师，博士研究生导师。中国临床肿瘤学会肿瘤微创外科专家委员会主任委员，上海市抗癌协会胃肠肿瘤腹腔镜专业委员会主任委员，上海市医学会普外科专科分会结直肠外科学组副组长，中国抗癌协会结直肠肿瘤整合康复专业委员会副主任委员，中国研究型医院学会结直肠肛门外科专业委员会副主任委员，中国初级卫生保健基金会结直肠癌专业委员会主任委员，中国临床肿瘤学会结直肠癌专家委员会常委，中国临床肿瘤学会结直肠癌诊治指南执笔人，中国医师协会肛肠医师分会常委，中国中西医结合学会普通外科专业委员会常委，中国抗癌协会肿瘤胃肠病学专业委员会常委，中国抗癌协会加速康复肿瘤外科专业委员会常委，中国中西医结合学会普通外科专业委员会直肠癌防治专家委员会主任委员，中华医学会中华消化外科教育学院副院长，国际结直肠癌协会（International Colon and Rectal Cancer Club，ICRCC）中国分会副主席。研究成果“直肠癌外科治疗全程管理模式的优化与推广”以第一完成人身份获2018年度（第十七届）上海医学科技奖二等奖和2019年度中华医学科技奖医学科学技术奖三等奖，研究成果“直肠癌规范化诊治体系的优化及推广”以第一完成人身份获2022年度中国抗癌协会科技奖二等奖。近5年以通信作者在SCI收录期刊上发表论文50余篇，主编专著4部，主译专著2部，获发明专利2项、实用新型专利2项。作为主要负责人承担国家级项目3项。" ]
- 基金信息：
  
  国家自然科学基金(81972260)
- DOI：10.19401/j.cnki.1007-3639.2025.07.001
  中图分类号： R735.3+7
- 收稿：2025-06-01，
  
  修回：2025-07-03，
  
  纸质出版：2025-07-30
- 稿件说明：
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李心翔, 骆大葵. 直肠癌外科治疗的创新模式探讨[J]. 中国癌症杂志, 2025,35(7):631-636.

Xinxiang LI, Dakui LUO. Exploring innovative models of surgical treatment for rectal cancer[J]. China Oncology, 2025, 35(7): 631-636.
李心翔, 骆大葵. 直肠癌外科治疗的创新模式探讨[J]. 中国癌症杂志, 2025,35(7):631-636. DOI： 10.19401/j.cnki.1007-3639.2025.07.001.

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

SIEGEL R L , WAGLE N S , CERCEK A , et al . Colorectal cancer statistics, 2023 [J ] . CA A Cancer J Clin , 2023 , 73 ( 3 ): 233 - 254 .

KELLER D S , BERHO M , PEREZ R O , et al . The multidisciplinary management of rectal cancer [J ] . Nat Rev Gastroenterol Hepatol , 2020 , 17 ( 7 ): 414 - 429 . DOI: 10.1038/s41575-020-0275-y http://doi.org/10.1038/s41575-020-0275-y

SAUER R , LIERSCH T , MERKEL S , et al . Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase Ⅲ trial after a median follow-up of 11 years [J ] . J Clin Oncol , 2012 , 30 ( 16 ): 1926 - 1933 .

BODY A , PRENEN H , LAM M , et al . Neoadjuvant therapy for locally advanced rectal cancer: recent advances and ongoing challenges [J ] . Clin Colorectal Cancer , 2021 , 20 ( 1 ): 29 - 41 .

VAN DER VALK M J M , HILLING D E , BASTIAANNET E , et al . Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study [J ] . Lancet , 2018 , 391 ( 10139 ): 2537 - 2545 .

GARCIA-AGUILAR J , PATIL S , GOLLUB M J , et al . Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy [J ] . J Clin Oncol , 2022 , 40 ( 23 ): 2546 - 2556 .

VERHEIJ F S , OMER D M , WILLIAMS H , et al . Long-term results of organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy: the randomized phase Ⅱ OPRA trial [J ] . J Clin Oncol , 2024 , 42 ( 5 ): 500 - 506 .

THOMPSON H M , OMER D M , LIN S , et al . Organ preservation and survival by clinical response grade in patients with rectal cancer treated with total neoadjuvant therapy: a secondary analysis of the OPRA randomized clinical trial [J ] . JAMA Netw Open , 2024 , 7 ( 1 ): e2350903 .

ASNONG A , D’HOORE A , VAN KAMPEN M , et al . The role of pelvic floor muscle training on low anterior resection syndrome: a multicenter randomized controlled trial [J ] . Ann Surg , 2022 , 276 ( 5 ): 761 - 768 .

CERCEK A , FOOTE M B , ROUSSEAU B , et al . Nonoperative management of mismatch repair-deficient tumors [J ] . N Engl J Med , 2025 , 392 ( 23 ): 2297 - 2308 .

LI Y J , PAN C H , GAO Y Y , et al . Total neoadjuvant therapy with PD-1 blockade for high-risk proficient mismatch repair rectal cancer [J ] . JAMA Surg , 2024 , 159 ( 5 ): 529 - 537 . DOI: 10.1001/jamasurg.2023.7996 http://doi.org/10.1001/jamasurg.2023.7996

LIN Z Y , ZHANG P , CHI P , et al . Neoadjuvant short-course radiotherapy followed by camrelizumab and chemotherapy in locally advanced rectal cancer (UNION): early outcomes of a multicenter randomized phase Ⅲ trial [J ] . Ann Oncol , 2024 , 35 ( 10 ): 882 - 891 .

YANG Y C , PANG K , LIN G L , et al . Neoadjuvant chemoradiation with or without PD-1 blockade in locally advanced rectal cancer: a randomized phase 2 trial [J ] . Nat Med , 2025 , 31 ( 2 ): 449 - 456 . DOI: 10.1038/s41591-024-03360-5 http://doi.org/10.1038/s41591-024-03360-5

XIA F , WANG Y Q , WANG H , et al . Randomized phase Ⅱ trial of immunotherapy-based total neoadjuvant therapy for proficient mismatch repair or microsatellite stable locally advanced rectal cancer (TORCH) [J ] . J Clin Oncol , 2024 , 42 ( 28 ): 3308 - 3318 .

GERARD J P , BARBET N , SCHIAPPA R , et al . Neoadjuvant chemoradiotherapy with radiation dose escalation with contact X-ray brachytherapy boost or external beam radiotherapy boost for organ preservation in early cT2-cT3 rectal adenocarcinoma (OPERA): a phase 3, randomised controlled trial [J ] . Lancet Gastroenterol Hepatol , 2023 , 8 ( 4 ): 356 - 367 .

XIA F , CHEN Y , WANG Y , et al . Short-course radiotherapy combined with chemotherapy and PD-1 inhibitor in proficient mismatch repair or microsatellite stable (pMMR/MSS) low-lying early rectal cancer: preliminary findings from a prospective, multi-center, phase Ⅱ trial (TORCH-E) [J ] . Ann Oncol , 2024 , 35: S462.

LI X X , LIANG L , SHI D B , et al . Vessel-centered laparoscopic total mesorectal excision via medial approach [J ] . Transl Cancer Res , 2018 , 7 ( 3 ): 744 - 757 .

李心翔 , 李清国 . 腹腔镜直肠癌术中左结肠动脉保留的意义 [J ] . 中华胃肠外科杂志 , 2018 , 21 ( 3 ): 272 - 275 .

LI X X , LI Q G . Significance of the preservation of left colic artery in laparoscopic resection of rectal cancer [J ] . Chin J Gastrointest Surg , 2018 , 21 ( 3 ): 272 - 275 .

《保留左结肠动脉的直肠癌根治术中国专家共识》编审委员会, 中国医师协会肛肠医师分会大肠癌综合治疗组, 中西医结合学会普通外科专业委员会直肠癌防治专家委员会 . 保留左结肠动脉的直肠癌根治术中国专家共识(2021版) [J ] . 中华胃肠外科杂志 , 2021 , 24 ( 11 ): 950 - 955 .

Editorial Committee of Chinese Expert Consensus on Radical Resection of Rectal Cancer with Preservation of Left Colorectal Artery (2021 edition); Comprehensive Treatment Group of Colorectal Cancer, Anorectal Doctor Branch, Chinese Medical Doctor Association; Expert Committee on Prevention and Treatment of Rectal Cancer, Special Committee for General Surgery, Society of Integrated Traditional Chinese and Western Medicine . Chinese expert consensus on radical resection of rectal cancer with preservation of left colonic artery (2021 edition) [J ] . Chin J Gastrointest Surg , 2021 , 24 ( 11 ): 950 - 955 .

CASSINOTTI E , AL-TAHER M , ANTONIOU S A , et al . European Association for Endoscopic Surgery (EAES) consensus on indocyanine green (ICG) fluorescence-guided surgery [J ] . Surg Endosc , 2023 , 37 ( 3 ): 1629 - 1648 . DOI: 10.1007/s00464-023-09928-5 http://doi.org/10.1007/s00464-023-09928-5

陈奕宽 , 翁俊勇 , 李心翔 . 荧光腹腔镜技术在结直肠外科的应用现状与进展 [J ] . 中国普通外科杂志 , 2024 , 33 ( 10 ): 1572 - 1579 .

CHEN Y K , WENG J Y , LI X X . Current status and advances in the application of fluorescence laparoscopy in colorectal surgery [J ] . Chin J Gen Surg , 2024 , 33 ( 10 ): 1572 - 1579 .

ZHUO C H , LIANG L , YING M G , et al . Laparoscopic low anterior resection and eversion technique combined with a nondog ear anastomosis for mid- and distal rectal neoplasms: a preliminary and feasibility study [J ] . Medicine (Baltimore) , 2015 , 94 ( 50 ): e2285 .

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