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中华结直肠疾病电子杂志 ›› 2016, Vol. 05 ›› Issue (06) : 463 -467. doi: 10.3877/cma.j.issn.2095-3224.2016.06.002

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直肠癌TME和ELAPE手术质量控制
王杉1,(), 申占龙1, 姜可伟1, 叶颖江1   
  1. 1. 100044 北京大学人民医院胃肠外科
  • 收稿日期:2016-09-16 出版日期:2016-12-25
  • 通信作者: 王杉
  • 基金资助:
    国家自然科学基金面上项目(No.81572379)

Surgical quality control of TME and ELAPE procedure for rectal cancer

Shan Wang1,(), Zhanlong Shen1, Kewei Jiang1, Yingjiang Ye1   

  1. 1. Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Peking University People′s Hospital, Beijing 100044, China
  • Received:2016-09-16 Published:2016-12-25
  • Corresponding author: Shan Wang
  • About author:
    Corresponding author: Wang Shan, Email:
引用本文:

王杉, 申占龙, 姜可伟, 叶颖江. 直肠癌TME和ELAPE手术质量控制[J/OL]. 中华结直肠疾病电子杂志, 2016, 05(06): 463-467.

Shan Wang, Zhanlong Shen, Kewei Jiang, Yingjiang Ye. Surgical quality control of TME and ELAPE procedure for rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2016, 05(06): 463-467.

解剖层面明确、手术质量可控制是手术进步的重要体现。在直肠癌的手术的发展上,全直肠系膜切除术(TME)和肛提肌外腹会阴联合切除术(ELAPE)属于手术质量控制的里程碑式手术。TME手术目前是中低位直肠癌的标准术式,要求直肠和直肠系膜作为一个解剖单位整体切除;ELAPE手术在减少传统腹会阴联合切除时存在"外科腰"方面(可能导致环周切缘阳性)可能具有一定价值。外科医师要做到手术质量控制,需要做好包括术前多学科专家组(MDT)评估、术中手术技术质控、术后标本质量病理学评估在内的一整套直肠癌手术质量控制体系。本文从上述三个方面对两种术式的手术质量控制进行论述。

Clear anatomical plane and surgical quality control are crucial points of operation development. In the history of rectal cancer surgery, total mesorectal excision (TME) and extralevator abodminoperineal excision (ELAPE) are two milestone style operations. TME has become the standard procedure of middle-low rectal cancer, ELAPE play an important role in decreasing the ″surgical waist″ (it might lead to circumferential resection margin positive) produced in conventional abdominoperienal excision procedure. The surgical quality control should include three aspects as followed: sufficient preoperative evaluation by multidisciplinary team (MDT), surgical technique quality control, postoperative pathological evaluation. The surgical quality control of two procedures was discoursed based on above three aspects

[1]
Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon[J]. CA Cancer J Clin, 1971, 21(6): 361-364.
[2]
Dixon CF. Surgical removal of lesions occurring in the sigmoid and rectosigmoid[J]. Am J Surg, 1939, 46, 12-17.
[3]
Parks AG,Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma[J]. Br J Surg, 1982, 69(6): 301-304.
[4]
Heald RJ,Husband EM,Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?[J]. Br J Surg, 1982, 69(10): 613-616.
[5]
Yorkshire Cancer Network Colorectal Group. Guidelines for Colorectal Cancer[EB/OL]. (2007-05-01)[2010-02-20].

URL    
[6]
Birbeck KF,Macklin CP,Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery[J]. Ann Surg, 2002, 235(4): 449-457.
[7]
Merkel S,Mansmann U,Siassi M, et al. The prognostic inhomogeneity in pT3 rectal carcinomas[J]. Int J Colorectal Dis, 2001, 16(5): 298-304.
[8]
Brown G,Radcliffe AG,Newcombe RG, et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging[J]. Br J Surg, 2003, 90(3): 355–364.
[9]
Burton S,Brown G,Daniels IR, et al. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?[J]. Br J Cancer, 2006, 94(3): 351-357.
[10]
Laghi A,Ferri M,Catalano C. Local staging of rectal cancer with MRI using a phased array body coil[J]. Abdom Imaging, 2002, 27(4): 425-431.
[11]
Gagliardi G,Bayar S,Smith R. Preoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils[J]. Arch Surg, 2002 , 137(4): 447-451.
[12]
Kaur H,Choi H,You YN. MR imaging for preoperative evaluation of primary rectal cancer: practical considerations[J]. Radiographics. 2012, 32(2): 389-409.
[13]
Mathur P,Smith JJ,Ramsey C. Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI[J]. Colorectal Dis, 2003, 5(5): 396-401.
[14]
Bellows CF,Jaffe B,Bacigalupo L, et al. Clinical significance of magnetic resonance imaging findings in rectal cancer[J]. World J Radiol, 2011, 3(4): 92-104.
[15]
Tveit KM. ESMO Guidelines Task Force. ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of rectal cancer[J]. Ann Oncol, 2003, 14(7): 1006-1007.
[16]
Nougaret S,Reinhold C,Mikhael HW, et al. The use of MR imaging in treatment planning for patients with rectal carcinoma: have you checked the ″DISTANCE″?[J]. Radiology, 2013, 268(2): 330-344.
[17]
García-Armengol J,García-Botello S,Martinez-Soriano F, et al. Review of the anatomicconcepts in relation to the retrorectal space and endopelvic fascia: Waldeyer’s fascia and the rectosacral fascia[J]. Colorectal Dis, 2008, 10(3): 298-302.
[18]
Christensen HK,Nerstrøm P,Tei T, et al. Perineal repair after extralevatorabdominoperinealexcision for low rectal cancer[J]. Dis Colon Rectum, 2011, 54(6): 711-717.
[19]
West NP,Anderin C,Smith KJ, et al. Multicentre experience with extralevator abdominoperineal excision for low rectal cancer[J]. Br J Surg, 2010, 97(4): 588-599.
[20]
叶颖江,申占龙,王杉. 肛提肌外腹会阴联合切除术的关键解剖和″两平面四边界″的手术原则[J]. 2014, 17(11): 1076-1080.
[21]
Haboubi N. Colonic surgery for cancer: a new paradigm[J]. Colorectal Dis, 2009, 11(4): 333-334.
[22]
Birgissona H,Talbackb M,Gunnarssona U, et al. Improved survival in cancer of the colon and rectum in Sweden[J]. Eur J Surg Oncol, 2005, 31(8): 845-853.
[23]
Hermanek P,Junginger T. The circumferential resection margin in rectal carcinoma surgery[J]. Tech Coloprotol, 2005, 9(3): 193-199.
[24]
Bernstein TE,Endreseth BH,Romundstad P, et al. Circumferential resection margin as a prognostic factor in rectal cancer[J]. Br J Surg, 2009, 96(11): 1348-1357.
[25]
Wibe A,Rendedal PR,Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer[J]. Br J Surg. 2002, 89(3): 327-334.
[26]
Baik SH,Kim NK,Lee YC, et al. Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer[J]. Ann Surg Oncol, 2007, 14(2): 462-469.
[27]
Luna-Pérez P,Bustos-Cholico E,Alvarado I, et al Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection[J]. J Surg Oncol, 2005, 90(1): 20-25.
[28]
Gosens MJ,Klaassen RA,Tan-Go I, et al. Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma[J]. Clin Cancer Res, 2007, 13(22 Pt 1): 6617-6623.
[29]
Nagtegaal ID,van Krieken JH. The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overview[J]. Eur J Cancer, 2002, 38(7): 964-972.
[30]
Nagtegaal ID,van de Velde CJ,van der Worp E, et al. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control[J]. J Clin Oncol, 2002, 20(7): 1729-1734.
[31]
Quirke P,Steele R,Monson J, et al. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: aprospective study using data from the MRC CR07 and NCIC-CTG CO16 rand omised clinical trial[J].Lancet, 2009,373(9666): 821-828.
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