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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 584 -588. doi: 10.3877/cma.j.issn.1674-3946.2022.05.030

综述

直肠癌新辅助治疗后等待观察策略的研究现状及进展
郝璐1, 袁野1, 余向南1, 李源2, 曹阳2, 陶凯雄2, 王征3, 王国斌2,†()   
  1. 1. 430022　武汉，华中科技大学同济医学院附属协和医院胃肠外科；430022　武汉，华中科技大学同济医学院附属协和医院组织工程与再生医学研究中心
    2. 430022　武汉，华中科技大学同济医学院附属协和医院胃肠外科；430022　武汉，华中科技大学同济医学院附属协和医院微创外科医学临床研究中心
    3. 430022　武汉，华中科技大学同济医学院附属协和医院胃肠外科；430022　武汉，华中科技大学同济医学院附属协和医院组织工程与再生医学研究中心；430022　武汉，华中科技大学同济医学院附属协和医院微创外科医学临床研究中心
  • 收稿日期:2021-11-29 出版日期:2022-10-26
  • 通信作者: 王国斌

Research status and progress of watch and wait strategy after neoadjuvant therapy for rectal cancer

Lu Hao1, Ye Yuan1, Xiangnan Yu1, Yuan Li2, Yang Cao2, Kaixiong Tao2, Zheng Wang3, Guobin Wang2,†()   

  1. 1. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China; Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China
    2. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China; Minimally Invasive Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China
    3. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China; Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China; Minimally Invasive Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei Province 430022, China
  • Received:2021-11-29 Published:2022-10-26
  • Corresponding author: Guobin Wang
  • Supported by:
    The Major Scientific and Technological Innovation Projects of Hubei Province(2018ACA136)
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郝璐, 袁野, 余向南, 李源, 曹阳, 陶凯雄, 王征, 王国斌. 直肠癌新辅助治疗后等待观察策略的研究现状及进展[J]. 中华普外科手术学杂志(电子版), 2022, 16(05): 584-588.

Lu Hao, Ye Yuan, Xiangnan Yu, Yuan Li, Yang Cao, Kaixiong Tao, Zheng Wang, Guobin Wang. Research status and progress of watch and wait strategy after neoadjuvant therapy for rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 584-588.

术前新辅助放化疗（nCRT）联合全直肠系膜切除术是目前局部进展期中低位直肠癌（LARC）的标准治疗模式。nCRT具有良好的降低肿瘤分期作用，且有15%~20%的LARC患者在nCRT后可以获得临床完全缓解（cCR）。鉴于手术潜在的术后并发症以及术后生存质量下降等考量，针对新辅助治疗后获得cCR的患者，有学者提出了等待观察策略（W&W）：即不接受手术，定期复查，从而保留器官功能，在不影响患者生存率的前提下提高生存质量。然而，W&W实施过程中出现出了以下问题：（1）应用何种新辅助治疗方案能尽可能地提高cCR率？（2）新辅助治疗后多久作为监测cCR的最佳时间？（3）cCR的正确评估及其与病理完全缓解（pCR）的关系？（4）接受W&W患者长期预后是否能达到同等手术根治效果？（5）W&W患者长期随访困难及可能的复发转移该如何处理？基于此，笔者通过对W&W开展以来的研究状况、cCR面临的争议点及研究方向等方面进行文献综述，为cCR患者的诊治提供一定的参考。

关键词: 直肠肿瘤, 新辅助治疗, 等待观察策略, 临床完全缓解

Preoperative neoadjuvant chemoradiotherapy（NCRT）combined with total mesenterectomy is the standard treatment mode for locally advanced rectal cancer（LARC）. NCRT has a good effect on reducing tumor stage，and 15% to 20% of LARC patients can obtain clinical complete remission（CCR）after NCRT. In view of the potential postoperative complications and decreased postoperative quality of life，some scholars proposed a watch and wait strategy（W&W）for patients with cCR after neoadjuvant therapy：no surgery，regular review，so as to preserve organ function and improve the quality of life without affecting the survival rate. However，the following problems emerged in the implementation of W&W：（1）Which neoadjuvant therapy can improve the cCR rate as much as possible？（2）How long is the best time to define cCR after neoadjuvant therapy？（3）The correct assessment of cCR and its relationship with pathological complete remission（pCR）？（4）Can the long-term prognosis of patients receiving W&W achieve the same effect of radical operation？（5）How to deal with the long-term follow-up difficulties and possible recurrence and metastasis of W&W patients？Based on this，the author made a literature review on the research status of W&W since its launch，the controversial points and research direction of cCR，so as to provide some reference for the diagnosis and treatment of clinical cCR patients.

Key words: Rectal neoplasms, Neoadjuvant therapy, Watch and wait, Clinical complete response
表1 直肠癌新辅助治疗后cCR患者W&W治疗策略的循证医学证据(例)
研究 时间 例 cCR(%) LR(%)
Renehan[18] 2016 259 31(12.0) 44(34)
Sanchez等[19] 2016 68 68(100.0) 6(8.8)
武爱文等[20] 2017 35 26(74.3) 5(14.3)
王林等[21] 2018 - 62（-） 15(24.2)
van der valk等[16] 2018 1009 880(87.2) 213(24.2)
Haak等[17] 2020 304 43(14.1) 5(11.6)
研究 时间 例 OS(%) DFS(%) 生存时间(年)
W&W 手术 W&W 手术
Renehan[18] 2016 259 96.0 87.0 88.0 78.0 3
Sanchez等[19] 2016 68 93.8 - 76.3 - 5
武爱文等[20] 2017 35 92.7 -

(CSS)

100.0

 - 3
王林等[21] 2018 - 88.6 - 100.0 - 3
van der valk等[16] 2018 1009 84.7 -

(DSS)

93.8

 - 5
Haak等[17] 2020 304 97.0 - 91.0 - 3
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