T4期结肠癌治疗策略选择  

Selection of treatment strategies for stage T4 colon cancer

作　　者：王一民 张木梓 孙凌宇[1] WANG Yi-min;ZHANG Mu-zi;SUN Ling-yu(Department of Oncology,the Fourth Affiliated Hospital of Harbin Medical University,Harbin 150000,China;不详)

机构地区：[1]哈尔滨医科大学附属第四医院肿瘤外科,黑龙江哈尔滨150000 [2]吉林市第二人民医院肿瘤内一科,吉林省吉林市132000

出　　处：《中国实用外科杂志》2024年第12期1417-1423,1429,共8页Chinese Journal of Practical Surgery

基　　金：黑龙江省博士后科研启动金资助项目(No.LBHQ19047)。

摘　　要：目前,普遍认为pT4a期结肠癌生存率高于pT4b期,但部分研究结果显示,pT4a期病人的腹膜转移发生率更高,p T4a与pT4b期病人预后相当甚至更差,故应关注pT4a病人腹膜转移的预防。对于T4期结肠癌应做好术前分期和错配修复基因检测,对于错配修复功能缺陷型结肠癌应给予新辅助免疫治疗,以提高病理完全缓解率。对于错配修复功能完整型cT4a期结肠癌,应给予3个月的新辅助化疗;对于错配修复功能完整型c T4b期结肠癌,可以升级新辅助治疗强度和(或)延长化疗周期。T4a期病人行腹腔镜手术时应尽可能避免直接接触肿瘤,预防腹膜转移。T4b期病人行联合器官切除可提高局部控制率和总体生存率。T4b期病人谨慎筛选后可行腹腔镜手术,若在腹腔镜下无法完成手术应及时中转开放手术。对于T4期结肠癌预防性腹腔热灌注化疗,推荐术中或者术后尽早进行,并选用耐受性良好的药物。It is commonly held that the survival rate for patients with pT4a stage colon cancer surpasses those of the pT4b stage.However,certain empirical investigations have indicated that patients at the pT4a stage exhibit a higher prevalence of peritoneal metastasis,and the prognostic outcomes of patients at the p T4a stage are comparable or even inferior to those at the pT4b stage.Consequently,greater emphasis should be directed towards the preventive measures against peritoneal metastasis for individuals at the pT4a stage.Patients with T4b stage colon cancer may enhance local control and prolong survival through the performance of multivisceral resection.Moreover,neoadjuvant immunotherapy should be administered to those with dMMR colon cancer to elevate the rate of pathological complete response(pCR).For patients with pMMR type cT4a stage colon cancer,a course of neoadjuvant chemotherapy spanning three months should be administered.In the case of pMMR type cT4b stage colon cancer,it may be advisable to intensify the neoadjuvant treatment regimen and/or extend the duration of the chemotherapy cycles.Direct contact with the tumor should be avoided as much as possible to prevent peritoneal metastasis when patients at the T4a stage undergo laparoscopic surgery.The management of T4b stage colon cancer places a greater emphasis on such surgical interventions.Patients at the T4b stage should undergo careful selection for laparoscopic surgery.If the procedure cannot be completed laparoscopically,it is imperative to promptly convert to open surgery.For T4 colon cancer,it is advisable to perform hyperthermic intraperitoneal chemotherapy(HIPEC)preventively as soon as possible,either during or following the surgical intervention.Additionally,a pharmacological agent with a favorable tolerance profile should be chosen for the treatment.

关 键 词：T4期结肠癌 腹膜转移 新辅助治疗 腹腔镜手术 联合器官切除 腹腔热灌注化疗 

分 类 号：R6[医药卫生—外科学]