Gavioli Margherita, Losi Lorena, Luppi Gabriele, Iacchetta Francesco, Zironi Sandra, Bertolini Federica, Falchi Anna Maria, Bertoni Filippo, Natalini Gianni
Divisione di Chirurgia II, Nuovo Ospedale Civile S. Agostino-Estense, Modena, Italy.
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):370-5. doi: 10.1016/j.ijrobp.2007.03.049. Epub 2007 May 24.
To assess the frequency and magnitude of changes in lower rectal cancer resulting from preoperative therapy and its impact on sphincter-saving surgery. Preoperative therapy can increase the rate of preserving surgery by shrinking the tumor and enhancing its distance from the anal sphincter. However, reliable data concerning these modifications are not yet available in published reports.
A total of 98 cases of locally advanced cancer of the lower rectum (90 Stage uT3-T4N0-N+ and 8 uT2N+M0) that had undergone preoperative therapy were studied by endorectal ultrasonography. The maximal size of the tumor and its distance from the anal sphincter were measured in millimeters before and after preoperative therapy. Surgery was performed 6-8 weeks after therapy, and the histopathologic margins were compared with the endorectal ultrasound data.
Of the 90 cases, 82.5% showed tumor downsizing, varying from one-third to two-thirds or more of the original tumor mass. The distance between the tumor and the anal sphincter increased in 60.2% of cases. The median increase was 0.73 cm (range, 0.2-2.5). Downsizing was not always associated with an increase in distance. Preserving surgery was performed in 60.6% of cases. It was possible in nearly 30% of patients in whom the cancer had reached the anal sphincter before the preoperative therapy. The distal margin was tumor free in these cases.
The results of our study have shown that in very low rectal cancer, preoperative therapy causes tumor downsizing in >80% of cases and in more than one-half enhances the distance between the tumor and anal sphincter. These modifications affect the primary surgical options, facilitating or making sphincter-saving surgery possible.
评估术前治疗导致低位直肠癌变化的频率和程度及其对保肛手术的影响。术前治疗可通过缩小肿瘤并增加其与肛门括约肌的距离来提高保肛手术的成功率。然而，已发表的报告中尚无关于这些改变的可靠数据。
对98例接受术前治疗的低位局部进展期直肠癌患者（90例uT3 - T4N0 - N+期和8例uT2N+M0期）进行直肠内超声检查。在术前治疗前后，以毫米为单位测量肿瘤的最大尺寸及其与肛门括约肌的距离。治疗后6 - 8周进行手术，并将组织病理学切缘与直肠内超声数据进行比较。
90例患者中，82.5%的肿瘤出现缩小，缩小程度从原始肿瘤体积的三分之一到三分之二或更多不等。60.2%的病例中肿瘤与肛门括约肌之间的距离增加。增加的中位数为0.73厘米（范围为0.2 - 2.5厘米）。肿瘤缩小并不总是伴随着距离的增加。60.6%的病例进行了保肛手术。在术前治疗前癌症已侵犯肛门括约肌的患者中，近30%的患者有可能进行保肛手术。这些病例的远切缘无肿瘤。
我们的研究结果表明，在极低位直肠癌中，术前治疗在超过80%的病例中导致肿瘤缩小，并且在超过一半的病例中增加了肿瘤与肛门括约肌之间的距离。这些改变影响了主要的手术选择，有助于或使保肛手术成为可能。
