局部进展期直肠癌精准治疗现状与展望OA

The treatment paradigm for locally advanced rectal cancer is undergoing a fundamental transformation from the traditional fixed triad of"radiotherapy-surgery-chemotherapy"to a holistic eco-system centered on precision stratification and multidisciplinary collaboration.This review synthesizes the current landscape and future perspectives of this evolution across four key dimensions.First,in surgical innovation,robotic-assisted surgery has demonstrated superiority over conventional laparoscopy in the narrow pelvis.High-quality evidence indicates that robot-assisted surgery(RAS)not only ensures better oncological outcomes,such as lower circumferential resection margin positivity,but also significantly improves functional recovery,including urinary and sexual functions.The field is further advancing to-wards the integration of intraoperative navigation,fluorescence imaging,and 5G remote collaboration.Second,molecular-guided immunotherapy is reshaping neoadjuvant strategies.While patients with defi-cient mismatch repair/microsatellite instability-high(dMMR/MSI-H)status achieve high rates of clinical complete response with immune checkpoint inhibitors,creating opportunities for organ preservation strate-gies like"Watch and Wait",research in the proficient mismatch repair/microsatellite stable(pMMR/MSS)population is pivoting towards synergistic radio-immunotherapy combinations to overcome immune-cold microenvironments.Third,artificial intelligence and radiomics are enabling non-invasive quantita-tive risk stratification and treatment response prediction.Beyond preoperative assessment,computer vi-sion is entering the operating room to identify critical anatomical structures(e.g.,nerves,ureters)in real-time and objectively assess surgical quality.Finally,liquid biopsy,particularly circulating tumor DNA,has emerged as a critical biomarker for minimal residual disease.Dynamic monitoring complements morphological imaging to guide decisions on treatment intensification or de-escalation.Collectively,these advances are driving locally advanced rectal cancer management towards a"biologically-driven"and"function-preserving"model.Future efforts must focus on establishing standardized protocols for these technologies and validating their long-term benefits in survival and quality of life through high-quality,multi-center clinical trials.