Kusters Miranda, Beets Geerard L, van de Velde Cornelis J H, Beets-Tan Regina G H, Marijnen Corrie A M, Rutten Harm J T, Putter Hein, Moriya Yoshihiro
Department of Surgery, Leiden University Medical Center, The Netherlands.
Ann Surg. 2009 Feb;249(2):229-35. doi: 10.1097/SLA.0b013e318190a664.
Differences exist between Japan and The Netherlands in the treatment of low rectal cancer. The purpose of this study is to analyze these, with focus on the patterns of local recurrence.
In The Netherlands, 755 patients were operated by total mesorectal excision (TME) for low rectal cancer, 379 received preoperative radiotherapy (RT+TME). Applying the same selection criteria resulted in 324 patients in the Japanese (NCCH) group, who received extended surgery consisting of lateral lymph node dissection and a wider abdominoperineal excision. The majority received no (neo) adjuvant therapy. Local recurrence images were examined by a radiologist and a surgeon.
Five-year local recurrence rates were 6.9% for the Japanese NCCH group, 5.8% in the Dutch RT+TME group, and 12.1% in the Dutch TME group. Recurrence rate in the lateral pelvis is 2.2%, 0.8%, and 2.7% in the Japanese, RT+TME group, and TME group, respectively. The incidence of presacral recurrences was low in the NCCH group (0.6%), compared with 3.7% and 3.2% in the RT+TME and TME groups, respectively.
Both extended surgery and RT+TME result in good local control, as compared with TME alone. Preoperative radiotherapy can sterilize lateral extramesorectal tumor particles. A wider abdominoperineal resection probably results in less presacral local recurrence. Comparison of the results is difficult because of differences in patient groups.
日本和荷兰在低位直肠癌的治疗方面存在差异。本研究旨在分析这些差异，重点关注局部复发模式。
在荷兰，755例低位直肠癌患者接受了全直肠系膜切除术（TME），379例接受了术前放疗（RT+TME）。应用相同的选择标准，日本（NCCH）组有324例患者，他们接受了包括侧方淋巴结清扫和更广泛的腹会阴联合切除术在内的扩大手术。大多数患者未接受（新）辅助治疗。由一名放射科医生和一名外科医生检查局部复发图像。
日本NCCH组的5年局部复发率为6.9%，荷兰RT+TME组为5.8%，荷兰TME组为12.1%。日本组、RT+TME组和TME组的侧盆腔复发率分别为2.2%、0.8%和2.7%。NCCH组的骶前复发发生率较低（0.6%），而RT+TME组和TME组分别为3.7%和3.2%。
与单纯TME相比，扩大手术和RT+TME均能实现良好的局部控制。术前放疗可使直肠系膜外的侧方肿瘤颗粒失活。更广泛的腹会阴联合切除术可能导致骶前局部复发较少。由于患者群体存在差异，结果比较困难。
