Expert consensus on multidisciplinary integrated preoperative clinical decision-making for low rectal cancer （2025 edition）

doi:10.3877/cma.j.issn.2095-3224.2025.03.003

Abstract

Abstract:

The incidence of low rectal cancer continues to rise annually， the research on low rectal cancer and the innovation of technology are constantly advancing and deepening. The new neoadjuvant treatment strategies and anus-preserving surgical plans formulated based on the multidisciplinary team （MDT）scheme closely affect the perioperative management， functional preservation effect， and long-term quality of life of patients. This consensus document establishes standardized multidisciplinary integrated care pathways for preoperative management， aiming to systematize clinical decision-making processes and promote standardized implementation across clinical practice.

Key words: Rectal neoplasms, Low rectal cancer, MDT, Preoperative decisionmaking, Consensus

Cancer Committee of the Chinese Medical Doctor Association Colorectal, Surgery Group of Surgery Branch of the Chinese Medical Association Colorectal, Branch of the Chinese Medical Doctor Association Anorectal, Rectal Cancer Anal Preservation Group，Colorectal Cancer Committee of the Chinese Medical Doctor Association Low. Expert consensus on multidisciplinary integrated preoperative clinical decision-making for low rectal cancer （2025 edition）[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(03): 221-233.

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References 121

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等级	描述	获益：风险与负担	证据的方法学质量	启示
1A	强烈推荐，高质量的证据	获益明显大于风险和负担反之亦然（即风险与负担明显高于获益）	来源于无重大缺陷的随机对照试验或观察性研究中获得的明确的证据	强烈推荐，即能够在绝大多数情况下无保留地适用于绝大多数患者
1B	强烈推荐，中等质量的证据	同上	来源于有重大缺陷的随机对照试验（结果矛盾、方法学有缺陷、间接证据或设计不严谨）或观察性研究的格外强的证据	强烈推荐，即能够在绝大多数情况下无保留地适用于绝大多数患者
1C	强烈推荐，低或极低质量的证据	同上	观察性研究或病例研究	强烈推荐，但高质量证据出现时可进行调整
2A	推荐程度弱，高质量的证据	获益接近于风险和负担	来源于无重大缺陷的随机对照试验或观察性研究中获得的明确的证据	推荐程度弱，根据具体情况或患者所处社会的价值取向决策
2B	推荐程度弱，中等质量的证据	同上	来源于有重大缺陷的随机对照试验（结果矛盾、方法学有缺陷、间接证据或设计不严谨）或观察性研究的格外强的证据	推荐程度弱，根据具体情况或患者所处社会的价值取向决策
2C	推荐程度弱，低或极低质量的证据	同上	观察性研究或病例研究	几乎不作推荐其他的选择也可能同样合理

等级	描述	获益：风险与负担	证据的方法学质量	启示
1A	强烈推荐，高质量的证据	获益明显大于风险和负担反之亦然（即风险与负担明显高于获益）	来源于无重大缺陷的随机对照试验或观察性研究中获得的明确的证据	强烈推荐，即能够在绝大多数情况下无保留地适用于绝大多数患者
1B	强烈推荐，中等质量的证据	同上	来源于有重大缺陷的随机对照试验（结果矛盾、方法学有缺陷、间接证据或设计不严谨）或观察性研究的格外强的证据	强烈推荐，即能够在绝大多数情况下无保留地适用于绝大多数患者
1C	强烈推荐，低或极低质量的证据	同上	观察性研究或病例研究	强烈推荐，但高质量证据出现时可进行调整
2A	推荐程度弱，高质量的证据	获益接近于风险和负担	来源于无重大缺陷的随机对照试验或观察性研究中获得的明确的证据	推荐程度弱，根据具体情况或患者所处社会的价值取向决策
2B	推荐程度弱，中等质量的证据	同上	来源于有重大缺陷的随机对照试验（结果矛盾、方法学有缺陷、间接证据或设计不严谨）或观察性研究的格外强的证据	推荐程度弱，根据具体情况或患者所处社会的价值取向决策
2C	推荐程度弱，低或极低质量的证据	同上	观察性研究或病例研究	几乎不作推荐其他的选择也可能同样合理

危险度分层	新辅助推荐	推荐级别
MRF（-），满足以下一条或多条：	LCRT	推荐
cT3a/b，未累及肛提肌；	SCRT
cN1-2，无结外种植；	新辅助化疗
EMVI（-）
MRF（-），满足以下一条或多条：	LCRT	推荐
cT3c/d 或极低位，未累及肛提肌；
cN1-2（结外种植）；
EMVI（+）
极高危组，满足以下任一条或多条：MRF（+）；	LCRT	推荐
cT4；	TNT
肛提肌受侵；	iTNT（SCRT+ 免疫治疗）
侧方淋巴结（+）
手术保留肛门括约肌有困难、患者有强烈保肛意愿者	TNT	推荐
	iTNT（SCRT+ 免疫治疗）

危险度分层	新辅助推荐	推荐级别
MRF（-），满足以下一条或多条：	LCRT	推荐
cT3a/b，未累及肛提肌；	SCRT
cN1-2，无结外种植；	新辅助化疗
EMVI（-）
MRF（-），满足以下一条或多条：	LCRT	推荐
cT3c/d 或极低位，未累及肛提肌；
cN1-2（结外种植）；
EMVI（+）
极高危组，满足以下任一条或多条：MRF（+）；	LCRT	推荐
cT4；	TNT
肛提肌受侵；	iTNT（SCRT+ 免疫治疗）
侧方淋巴结（+）
手术保留肛门括约肌有困难、患者有强烈保肛意愿者	TNT	推荐
	iTNT（SCRT+ 免疫治疗）

检查项目	临床完全缓解	近临床完全缓解	肿瘤残留
直肠指诊——必选	正常	黏膜轻度异常	可触及明显肿瘤结节
直肠MR——必选（mrTRG^a）	mrTRG 1	mrTRG 1～2	mrTRG 3～5
内镜——必选（黏膜形态）	接近正常^b	轻度异常^c	可见肿瘤
——可选（黏膜活检）	活检无肿瘤残留^d	黏膜活检无肿瘤残留^e	黏膜活检可见肿瘤残留^e
经直肠穿刺活检——可选	-	未见肿瘤残留^e	-
血清癌胚抗原——可选	正常^e	正常	正常或升高

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