新辅助放化疗后直肠癌手术的初步审计经验。
A preliminary audit experience of surgery for rectal cancer after neoadjuvant chemoradiation therapy.
作者信息
Ugolini Giampaolo, Rosati Giancarlo, Montroni Isacco, Manaresi Alessio, Blume Julia Friederike, Schifano Domenico, Zattoni Davide, Taffurelli Mario
机构信息
Department of General Surgery Emergency and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
出版信息
Tumori. 2010 Mar-Apr;96(2):260-5. doi: 10.1177/030089161009600212.
AIMS AND BACKGROUND
A surgical audit is a systematic critical analysis of surgical performance, with the goal to improve the quality of patient care. Rectal cancer surgery is one of the most delicate procedures in the field of surgical oncology, with significant variations in terms of complications from center to center. Neoadjuvant chemoradiation therapy leads to a significant reduction in local recurrences in patients with locally advanced lower and medium rectal cancer. The aim of the study was to evaluate the influence of neoadjuvant chemoradiation therapy on postoperative morbidity and mortality in patients with rectal cancer.
METHODS AND STUDY DESIGN
From January 1, 2003, to December 31, 2007, patients who underwent elective surgical resection for lower and medium rectal cancer in our Surgical Unit were prospectively analyzed. Patients (n=42) were divided into two groups: (1) those treated with neoadjuvant chemotherapy and consequent surgical resection (19/42); (2) those treated with primary surgical treatment (23/42). P-POSSUM (Portsmouth Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity) and CR-POSSUM (ColoRectal-POSSUM) scores were calculated for each patient group. Thirty-day mortality and morbidity rates were prospectively collected in a comprehensive data base. Data were evaluated by comparing the predictions of the two scoring systems in both study groups with clinically observed mortality and morbidity rates.
RESULTS
In group 1, no death was registered (0/19). The P-POSSUM and CR-POSSUM expected mortality was 2.43% and 4.52%, respectively (P > 0.05). In group 2, a single death was documented (1/23, 4.35%). The P-POSSUM and CR-POSSUM expected mortality was 2.1% and 4.94%, respectively. The postoperative complications rate for group 1 was 10.52% (2/19) compared to 34.88% as expected from the P-POSSUM score (P < 0.05). In group 2, a postoperative complication rate of 39.13% (9/23) was observed compared to 34.26% as expected from the P-POSSUM score (P > 0.05).
CONCLUSIONS
No significant influence on morbidity or mortality was detected in patients who underwent neoadjuvant radio-chemotherapy.
目的与背景
外科审计是对手术表现进行的系统批判性分析，旨在提高患者护理质量。直肠癌手术是外科肿瘤学领域中最精细的手术之一，各中心在并发症方面存在显著差异。新辅助放化疗可显著降低局部进展期低位和中位直肠癌患者的局部复发率。本研究的目的是评估新辅助放化疗对直肠癌患者术后发病率和死亡率的影响。
方法与研究设计
对2003年1月1日至2007年12月31日在我们外科接受低位和中位直肠癌择期手术切除的患者进行前瞻性分析。患者（n = 42）分为两组：（1）接受新辅助化疗并随后进行手术切除的患者（19/42）；（2）接受一期手术治疗的患者（23/42）。为每个患者组计算P-POSSUM（朴茨茅斯生理和手术严重程度评分以计算死亡率和发病率）和CR-POSSUM（结直肠癌-POSSUM）评分。前瞻性地在一个综合数据库中收集30天死亡率和发病率数据。通过比较两个研究组中两种评分系统的预测结果与临床观察到的死亡率和发病率来评估数据。
结果
第1组未记录到死亡（0/19）。P-POSSUM和CR-POSSUM预期死亡率分别为2.43%和4.52%（P>0.05）。第2组记录到1例死亡（1/23，4.35%）。P-POSSUM和CR-POSSUM预期死亡率分别为2.1%和4.94%。第1组术后并发症发生率为10.52%（2/19），而P-POSSUM评分预期为34.88%（P<0.05）。第2组观察到的术后并发症发生率为39.13%（9/23），而P-POSSUM评分预期为34.26%（P>0.05）。
结论
接受新辅助放化疗的患者在发病率或死亡率方面未检测到显著影响。
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