Masaki Tadahiko, Takayama Makoto, Matsuoka Hiroyoshi, Abe Nobutsugu, Ueki Hisayo, Sugiyama Masanori, Tonari Ayako, Kusuda Junko, Mizumoto Shinsaku, Atomi Yutaka
Department of Surgery, Kyorin University, Tokyo, Japan.
Langenbecks Arch Surg. 2008 Mar;393(2):173-80. doi: 10.1007/s00423-007-0260-8. Epub 2008 Jan 3.
Pelvic autonomic nerve preservation (PANP) with lateral lymph node dissection (LLND) has been introduced in rectal cancer surgery in Japan; however, its indication has not been standardized yet.
Forty-four patients with advanced lower rectal cancer were randomized to either the standard treatment group (control group) or the intraoperative radiotherapy (IORT) group. All patients underwent potentially curative resection of the rectum with total mesorectal excision. The control group underwent bilateral LLND and limited PANP. The IORT group underwent bilateral LLND, complete PANP, and IORT. Patients allocated to the IORT group received IORT to the bilateral preserved pelvic nerve plexuses. Patients' clinicopathologic parameters, postoperative complications, voiding function, and prognosis were compared between the two groups.
Among 44 patients enrolled, three patients were excluded from the analysis, resulting in 19 patients in the IORT group and 22 patients in the control group. Patients' demographic and pathological parameters and postoperative complications were well balanced between the two groups. Oncological outcomes including overall and disease-free survival were also similar. Local recurrence was observed in one patient in each group. Among the 34 patients not complicated with intrapelvic abscess, the mean duration of urinary catheter indwelling was 8 days in the IORT group and 13 days in the control group (p = 0.055). In the long term, medication for urination was necessitated in four patients in the control group, whereas in none in the IORT group (p = 0.059).
Oncological outcomes in the IORT group are equal to those in the control group, and voiding functions in the IORT group are superior to those in the control group. These results suggest that IORT may be useful to expand the indication of complete PANP with LLND for advanced lower rectal cancer.
在日本，直肠癌手术中已引入保留盆腔自主神经（PANP）联合侧方淋巴结清扫（LLND）；然而，其适应证尚未标准化。
44例晚期低位直肠癌患者被随机分为标准治疗组（对照组）或术中放疗（IORT）组。所有患者均接受直肠全直肠系膜切除术的根治性切除。对照组行双侧LLND和有限的PANP。IORT组行双侧LLND、完全PANP和IORT。分配至IORT组的患者接受双侧保留盆腔神经丛的IORT。比较两组患者的临床病理参数、术后并发症、排尿功能和预后。
在纳入的44例患者中，3例患者被排除在分析之外，结果IORT组有19例患者，对照组有22例患者。两组患者的人口统计学和病理参数以及术后并发症均衡良好。包括总生存和无病生存在内的肿瘤学结局也相似。每组各有1例患者出现局部复发。在34例未并发盆腔内脓肿的患者中，IORT组平均导尿留置时间为8天，对照组为13天（p = 0.055）。长期来看，对照组有4例患者需要排尿药物治疗，而IORT组无一例（p = 0.059）。
IORT组的肿瘤学结局与对照组相当，且IORT组的排尿功能优于对照组。这些结果表明，IORT可能有助于扩大LLND联合完全PANP治疗晚期低位直肠癌的适应证。
