Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2010 Sep 1;78(1):156-63. doi: 10.1016/j.ijrobp.2009.07.1684. Epub 2010 Jan 26.
The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection.
We reviewed 285 patients who received preoperative CRT and 418 patients who received postoperative CRT between January 2000 and December 2006.
There was no between-group difference in age, gender, or cancer stage. In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 +/- 1.4 cm vs. 4.3 +/- 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group. Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively). Small bowel obstruction (arising from radiation enteritis) requiring surgical intervention was more frequent in the post-CRT group (0% in the pre-CRT group vs. 1.4% in the post-CRT group, p = 0.042). Multivariate analysis identified preoperative CRT as an independent risk factor for fistulous complications (delayed anastomotic leakage, rectovaginal fistula, rectovesical fistula), and postoperative CRT as a risk factor for obstructive complications (anastomotic stricture, small bowel obstruction). The stoma-free rates were significantly lower in the pre-CRT group than in the post-CRT group (5-year stoma-free rates: 92.8% vs. 97.0%, p = 0.008).
The overall postoperative complication rates were similar between the pre-CRT and the Post-CRT groups. However, the pattern of postoperative complications seen after sphincter- saving resection differed with reference to the timing of CRT.
本研究旨在比较术前放化疗（CRT）与术后 CRT 对接受保肛手术的直肠癌患者术后并发症发生率和类型的影响。
我们回顾了 2000 年 1 月至 2006 年 12 月期间接受术前 CRT 的 285 例患者和接受术后 CRT 的 418 例患者。
两组患者的年龄、性别或癌症分期无差异。在术前 CRT 组中，吻合口距肛缘的平均水平较低（3.5±1.4cm 比 4.3±1.7cm，p<0.001），T4 病变和暂时性转流性回肠造口术的发生率高于术后 CRT 组。术前 CRT 组延迟性吻合口漏和直肠阴道瘘的发生率高于术后 CRT 组（3.9%比 1.2%，p=0.020；6.5%比 1.3%，p=0.027）。术后 CRT 组需要手术干预的小肠梗阻（由放射性肠炎引起）更为常见（术前 CRT 组为 0%，术后 CRT 组为 1.4%，p=0.042）。多因素分析确定术前 CRT 是瘘管并发症（延迟性吻合口漏、直肠阴道瘘、直肠膀胱瘘）的独立危险因素，而术后 CRT 是梗阻性并发症（吻合口狭窄、小肠梗阻）的危险因素。术前 CRT 组的无造口率明显低于术后 CRT 组（5 年无造口率：92.8%比 97.0%，p=0.008）。
术前 CRT 组与术后 CRT 组的总体术后并发症发生率相似。然而，保肛手术后的术后并发症模式因 CRT 的时机而异。
