Watanabe Toshiaki, Tsurita Giichiro, Muto Tetsuichiro, Sawada Toshio, Sunouchi Koki, Higuchi Yoshiki, Komuro Yasuhiro, Kanazawa Takamitsu, Iijima Takeru, Miyaki Michiko, Nagawa Hirokazu
Department of Surgery, University of Tokyo Hospital, the Cancer Institute Hospital, Japan.
Surgery. 2002 Jul;132(1):27-33. doi: 10.1067/msy.2002.125357.
Extended lymphadenectomy including lateral node dissection (EXT-L) contributes to a low incidence of local recurrence of lower rectal cancer. However, EXT-L is frequently associated with impairment of sexual and urinary function. We therefore compared the effectiveness of preoperative radiotherapy with that of EXT-L.
One hundred fifteen patients were studied. Seventy-eight patients underwent preoperative radiotherapy with a total dose of 50 Gy (Rad[+] group), and 37 did not (Rad[-] group). Seventy-five patients received EXT-L (EXT-L[+] group), and 40 did not (EXT-L[-] group). Patients were further divided into 4 subgroups (Rad[+]&EXT-L[-], Rad(+)&EXT-L[+], Rad[-]&EXT-L(+), and Rad[-]&EXT-L[-]), and clinicopathologic features were examined. In the Rad(+) group, the relation between the p53 gene and survival was also examined.
There was a significant difference in disease-free survival between the Rad(+) and Rad(-) groups (5-year disease-free survival rate, 74.6% vs 45.9%; P =.006). However, there was no significant difference between the Rad(+)&EXT-L[-] and Rad[-]&EXT-L(+) groups. The p53 gene status did not affect survival in the Rad(+) group.
This study suggests that in terms of curative effect, preoperative radiotherapy can be one alternative therapy in place of EXT-L for patients with lower rectal cancer.
包括侧方淋巴结清扫术（EXT-L）在内的扩大淋巴结清扫术有助于降低低位直肠癌的局部复发率。然而，EXT-L常常会导致性功能和泌尿功能受损。因此，我们比较了术前放疗与EXT-L的疗效。
对115例患者进行了研究。78例患者接受了总剂量为50 Gy的术前放疗（放疗阳性组），37例未接受术前放疗（放疗阴性组）。75例患者接受了EXT-L（EXT-L阳性组），40例未接受（EXT-L阴性组）。患者进一步分为4个亚组（放疗阳性&EXT-L阴性、放疗阳性&EXT-L阳性、放疗阴性&EXT-L阳性和放疗阴性&EXT-L阴性），并对临床病理特征进行了检查。在放疗阳性组中，还研究了p53基因与生存率之间的关系。
放疗阳性组和放疗阴性组的无病生存率存在显著差异（5年无病生存率分别为74.6%和45.9%；P = 0.006）。然而，放疗阳性&EXT-L阴性组和放疗阴性&EXT-L阳性组之间没有显著差异。p53基因状态在放疗阳性组中不影响生存率。
本研究表明，就疗效而言，术前放疗可作为低位直肠癌患者替代EXT-L的一种治疗选择。
