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??Combined multimodality in the treatment of distal rectal cancer ZHANG Zhen. Department of Radiation Oncology, Cancer Hospital, Fudan University, Shanghai 200032,China Abstract German trial has showed the benefit of neoadjuvant chemoradiation compared with adjuvant chemoradiation in the management of rectal cancer and it has been the preference standard of care of stage II and III rectal cancer. Tumor location is known to be an important prognostic factor in results of treatment. Consensus are not reached in the treatment of distal rectal cancer, especially in the radiation style, short course vs long course; radiation alone or chemoradiation and patient selection. There is no universal model for the neoadjuvant chemoradition of distal rectal cancer. Multidisciplary approach and fully consideration should be taken.     

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??Diagnosis and treatment of medium low rectal cancer in the status quo and outlook WANG Jian-ping. Department of Gastrointestinal Surgery, the Sixth Affiliated (Gastrointestinal and Anal Hospital) of Sun Yat-sen University, Guangzhou 510655, China Abstract Middle-low rectal cancer is a common disease with high morbidity. It is of vital importance for early detection and early treatment, which results in high survival rate. In addition, it is becoming routine to provide prognostic and predictive factors for treatment selection and prognosis when diagnosing. The progress in image methods has made reliable information for pre-treatment diagnosis and staging, which helps to make treatment strategy. Multi-disciplinary treatment and individual treatment are two major principles when treating middle-low rectal cancer. More and more studies are carried on to find the best combination of operation, radiation and chemotherapy. The aims of treatment are to improve survival rate as well as to maintain the function of anus and pelvic automatic nerve. Quality of life is the crucial focus during the whole process of treating patients with middle-low rectal cancer.     

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??Standard of pathological evaluation for mid-low rectal cancer YAO Hong-wei*??LI Wen-di??TIAN Mao-lin??et al. *Department of General Surgery??Peking University Third Hospital??Beijing100191, China
Corresponding author: SHI Xue-ying??E-mail??zhsh6812@aliyun.com??LIU Yin-hua??E-mail??liuyinhua@medmail.com.cn
Abstract Pathological examination plays a core role in the multi-disciplinary diagnosis and treatment of rectal cancer. It can evaluate the effect of neoadjuvant therapy and operation??can assist postoperative adjuvant therapy??and can even predict cancer recurrence and risk degree of patient's prognosis. Anatomy and TNM staging are the basis of pathological assessment of mid-low rectal cancer. Standardized evaluation of routine pathology includes resection range??tumor site??tumor size??gross type??distance between tumor and bowel margin??grade of cancer??depth of invasion (T staging)??number of lymph nodes evaluated and number positive (N staging)??status of proximal and distal margin??circumferential resection margin??response of neoadjuvant therapy??lymphovascular invasion??perineural invasion??and tumor deposition. Molecular pathological diagnosis plays more and more prominent role in the choice of drug and prognosis assessment.     

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尽管外科手术一直都是治疗直肠癌的主要手段,但单纯的手术疗法效果不尽人意。近年来,术前放、化疗在中低位直肠癌治疗中的作用已经在越来越多的临床实践中得到验证。新辅助疗法的引入,在降低肿瘤局部复发率、提高保肛率、延长病人的生存时间等方面均取得了明显进步。1术前放化疗方案术前化疗还没有统一方案,目前多数临床研究是以5-氟脲嘧啶(5-FU)为基础联合化疗方案。有研究表明,联合用药可以提高完全缓解率。联合应用较多的有甲酰四氢叶酸(LV)。近年,不少新药应用于直肠癌治疗,取得了良好的效果,如卡培他滨、雷替曲塞、奥沙利铂和伊立替…     

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与结肠癌相比,直肠癌尤其是中低位直肠癌在解剖和治疗学上有许多不同之处。首先大多数中低位直肠癌病人面临着是进行传统的经腹会阴联合切除,还是进行保留括约肌的保肛手术的问题。其次,虽然近年来随着手术技术的不断改进,尤其是在全直肠系膜切除(TME)技术得到推广以后,病人的保肛率、长期生存率得到明显的提高,但是术后局部复发仍然是直肠癌手术失败的重要原因之一,尤其是直肠癌侵犯深达全层以上、淋巴结有转移或周边切缘肿瘤阳性的病人,盆腔或局部复发的机会仍然比较高,即使采用TME技术,仍然可达5%～40%。另外,由于直肠位于狭小的盆腔…     

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Ｍｉｌｅｓ手术是治疗直肠癌的经典术式 ,但所造成的腹壁永久性人工肛门给病人带来痛苦和生活不便 ,生存质量下降 ,病人难以接受。近几十年来关于直肠癌的病理和免疫等各方面的研究进展以及手术操作的熟练 ,尤其是端端吻合 (ＥＥＡ)吻合器的应用 ,使一部分直肠中低位的癌肿应用前切除术 (Ｄｉｘｏｎｓ手术 )既免受人工肛门之苦 ,又能获得较满意的疗效。本文对 1 992～ 1 997年我们医院收治的 2 8例距肛缘 6～ 8ｃｍ的中低位直肠癌应用改进的ＥＥＡ吻合器吻合方法行低位前切除术进行研究分析并就相关的问题进行探讨。1　临床资料1 1　一般…     

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??Pathology of the mid-lower rectal carcinoma ZHU Xiong-zeng. Department of Patholgy, Cancer Hospital, Fudan University, Shanghai 200032, China Abstract The rectum is the most common site of the large bowel carcinoma. In rectal carcinoma, about 70% cases are located in the mid-lower rectum. Also some issues have been mantioned at histopathological diagnosis, including (1) the concept of the intraepithelial neoplasia (I N) and the relationship with surgical treatment, especially introducing the Vinna classification of gastronitesinal epithelial neoplasia and clinical management. (2) the prognostic paremeters determined by histopathology, such as resected margins, extent of extracolorectal invasion, reginal nodal metastases, vascular and perineural invasion, and (3) genetics of the large bowel cancers, mainly about hereditary nonpolyposis colorectal cancer(HNPCC) and familial adenomatous polyposis(FAP).     

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198 5年 5月至 1998年 12月我科对 5 6例直肠癌病人施行Dixon手术 ,取得了良好的效果。现报道如下。1　资料与方法本组 5 6例 ,男 3 8例 ,女 18例。年龄 2 2 72岁。肿瘤下缘距肛缘的距离 68cm 3 6例 ,910cm 2 0例 ,平均 8cm。Dukes分期为A期 8例 ,B期 3 8例 ,C期 10例。病理诊断高、中分化腺癌 3 7例 ,粘液腺癌 8例 ,低分化腺癌 9例 ,未分化癌 2例。所有病例探查肿瘤位于盆底腹膜返折水平或以下 ,无远处转移病灶 ,按直肠癌根治原则行全直肠系膜切除(TME) ,直视下在骶前间隙进行锐性分离 ,保持包裹直肠系膜的盆筋膜脏层的完整无损 ,以防…     

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??iagnosis and treatment of local recurrent mid-lower rectal cancer WANG Zhen-jun. Department of General Surgery, Beijing Chaoyang Hospital,Capital Medical University, Beijing 100020,China Abstract Local recurrence of mid-lower rectal cancer persistently constitutes a challenging clinical problem. Recurrent lesion often located in anastomosis, perineum, osteal pelvis and adjacent organs in the pelvis. Clinical manifestation of local recurrent rectal cancer (LRRC) patients include blood stool, perineal pain, pelvic and presacral lump, et al. Regular postoperative physical examination, CT, MRI as well as tumor markers are important methods for diagnosis of LRRC. The treatment choice include excision as the main part of multimodality treatment or palliative radiochemotherapy on comprehensive analysis of type of recurrence, cancer biological features and involvement extent of recurrent cancer.     

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中低位直肠癌最主要的治疗手段目前仍然是手术根治性切除,但近10余年间治疗策略发生了很大的变化。以往,术前诊断的重点是定性诊断,强调的是手术的根治性或能否保肛。当前,直肠癌术前分期诊断受到重视,针对不同分期选择治疗方式及术式,使病人最大限度的收益。对于不伴有不良预后因素的T1N0M0期早期直肠癌可以慎重选择局部切除术;对于局部中晚期直肠癌[T3~4期和(或)伴有区域性淋巴结转移]推荐术前放化疗然后再行手术;而对于伴有肝、肺等远处转移的直肠癌病人,根据情况决定原发病灶是否需要切除。     

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??Assesment of laparoscopic surgery for mid-low rectal cancer LI Guo-xin.Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China Abstract The technical safty and feasibility of laparoscopic procedure for mid-low rectal cancer were confirmed by increasing clinical studies .The short-term advantages of fast postoperative recovery,less pain and short hospital stay for laparoscopic rectal cancer surgery were shown in a growing body of literatures. Laparoscopic surgery for mid-low rectal cancer could strictly adhere to the oncological principle to guarantee the oncologic safty . Laparoscopic approach might be superior to the open surgery in terms of anal sphincter saving and impact on bladder and sexual function,and could be safe and feasible in total mesorectal excision with preoperative chemoradiation therapy.In conclusion,the data from the recent trials have shown promising clinical benefits of short-term advantages as well as long-term oncologic equivalence for laparoscopic surgery for mid-low rectal cancer.However,adequately powered,multiple center trials are justified and necessary to assess the role of laparoscopy in mid-low rectal cancer surgery.     

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??Endoscopic submucosal dissection in the trearment of lower rectal tumor YAO Li-qing, ZHONG Yun-shi. Endoscopic Center, Zhongshan Hospital of Fudan University, Shanghai 200032,China Corresponding author: ZHONG Yun-shi, E-mail:zhongamy2002@126.com Abstract There were disputations of local resection of rectal cancer, in this article we reviewed the development, intradiction, methods of endoscopic resection and the value in the treatment of lower rectal tumor??especially focused on endoscopic submucosa dissection, including instrument, methods, postoperative treatment and effect.     

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??A dispute over lateral lymph node dissection in lower rectal cancer SHI Ying-qiang. Department of Abdominal Surgery, Cancer Hospital,Fudan University??Shanghai 200032, China Abstract Lateral lymph node dissection for lower rectal cancer varies a lot in its extent, indication and effect between surgeons in different countries or background. It is commonly believed that patients with tumor in lower rectal, high grade or T3-4 invasion should be the candidate for lateral lymph node dissection, in whom a radionuclide image, endosonography and PET-CT can be utilized for evaluating the lymph node status preoperatively. Lateral lymph node dissection should be proceeded by a proficient and skill-full surgeon, for whom dissection should be carried on along the space between intra-iliac vessels, pelvic wall and obturator facial plane until the obturator nerve is exposed. The number of lymph nodes dissection for pathological examination should be at least 10. Up to now, the effect of lateral lymph node dissection to decrease the local recurrence rate has been confirmed worldwide, but its necessity is still controversial and debated by large clinical trails. From the author’s view, lateral node dissection for lower rectal cancer is valuable and efficient. Modified or elective lateral node dissection with TME or even in laparoscopy may be a prospective direction in the future for the treatment of patients with lower rectal cancer.     

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乳管内乳头状瘤因病灶微小,临床不易触及,辅助检查没有特征性表现而难于诊断和治疗,特别是手术中因探查不到病灶而多行局部扩大切除,导致不必要的损伤。我院自2001年利用乳管镜术中定位切除单一乳管内肿瘤24例,临床效果满意。总结报告如下。1　资料与方法1.1　一般资料　2001年     

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??Decision-making on surgical therapy of low-third rectal cancer based on anatomy GU Jin??DU Chang-zheng. Peking University School of Oncology, Beijing Cancer Hospital &Institute??Beijing100142,China Corresponding author:GU Jin, E-mail:zlguj@yahoo.com.cn Abstract Rectal cancer is one of the most common cancers, and 75% locate at low-third rectum. Surgery is predominant therapy for rectal cancer. During the past decades,radiotherapy and more recently radiochemotherapy have been increasingly used together with surgery in the primary management of patients with rectal caner. Radical procedure of rectal cancer based on anatomy involves vascular ligation, pelvic autonomic nerve preservation(PANP), lymph nodes resection, total mesorectal excision(TME) and sphincter preservation.     

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??Application and appraisal of sphincter-preserving strategies in mid-low rectal cancer treated by preoperative chemoradiotherapy SU Xiang-qian??YANG Hong. Department of Minimally Invasive Gastrointestinal Surgery??Beijing Cancer Hospital & Institute??Peking University Cancer Hospital??Peking University School of Oncology??Key laboratory of Carcinogenesis and Translational Research (Ministry of Education)??Beijing 100142??China
Corresponding author??SU Xiang-qian??E-mail??suxiangqian@bjmu.edu.cn
Abstract The standard treatment for patients with locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. It is supported by randomized trials. But many controversial matters in the surgical management of rectal cancer still need to be defined??such as the optimal time interval between completion of chemoradiotherapy and surgery??adequate distal resection margin and circumferential resection margin??sphincter-preserving and conservative management??including local excision and ‘wait and see’ policy.