Ulrich Alexis, Weitz Jürgen, Slodczyk Matthias, Koch Moritz, Jaeger Dirk, Münter Marc, Büchler Markus W
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):129-36. doi: 10.1016/j.ijrobp.2008.10.051. Epub 2009 Mar 21.
To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy.
This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed.
A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m(2) (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome.
The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.
确定原发性直肠癌切除患者围手术期发病的危险因素,特别关注新辅助治疗的影响。
对前瞻性收集的数据进行的这项探索性分析纳入了2001年10月至2006年10月期间因原发性直肠癌接受前切除术/低位前切除术或腹会阴联合切除术的所有患者。研究终点为围手术期手术和医疗发病率。对潜在危险因素进行单因素和多因素分析。
本研究共纳入485例患者;425例患者(88%)接受了保留括约肌的前切除术/低位前切除术,47例(10%)接受了腹会阴联合切除术,13例(2%)接受了多脏器切除术。100例患者(21%)接受了新辅助放化疗,168例(35%)接受了新辅助短期放疗(5×5 Gy)。患者年龄和手术时间与围手术期发病率独立相关,手术时间、体重指数>27 kg/m²(超重)和切除类型与手术发病率相关。年龄和吸烟史被确认为医疗并发症的独立预后危险因素。新辅助治疗与较差的结局无关。
这项前瞻性研究的结果确定了与直肠癌手术后围手术期不良结局相关的几个危险因素。此外,新辅助治疗与围手术期并发症增加无关。