Ruppert R, Ptok H, Strassburg J, Maurer C A, Junginger T, Merkel S, Hermanek P
Städtische Kliniken München, Klinikum Neuperlach, Klinik für Allgemein- und Visceralchirurgie, endokrine Chirurgie und Coloproktologie, München, Deutschland.
Carl-Thiem-Klinik, Klinik für Chirurgie, Cottbus, Deutschland.
Zentralbl Chir. 2013 Dec;138(6):630-5. doi: 10.1055/s-0031-1283922. Epub 2012 Jun 14.
The interim analysis of a prospective multicentre observational study of selective neoadjuvant chemoradiotherapy (OCUM) in patients with rectal cancer should evaluate the quality of diagnosis and therapy as a prerequisite for continuation of the study.
230 patients with the clinical stage cT2 - 4, each cN, M0 with radical tumour resection were enrolled until now. The values of 13 quality indicators were compared with the target values formulated by the workflow of the Working Group rectal cancer II and the German Cancer Society and were also compared with the results of the certified bowel centres of Germany 2010.
The target values were fulfilled to a high degree regardless of caseload. 83 % of parameters have been fully achieved and 14 % nearly achieved. In primary surgery the proportion of patients with 12 or more histologically examined lymph nodes was 99.2 %, after neoadjuvant chemoradiotherapy 90 %. A R0 resection was performed in 98.3 % and a resection of TME in muscularis propria plane only in 2.2 %. The rate of positive circumferential resection margins (pCRM + ) was 5.7 % only.
The high quality of rectal surgery justifies the concept and the continuation of the study.
一项关于直肠癌患者选择性新辅助放化疗(OCUM)的前瞻性多中心观察性研究的中期分析,应将诊断和治疗质量评估作为研究继续进行的前提条件。
截至目前,共纳入230例临床分期为cT2-4、各cN、M0且行根治性肿瘤切除术的患者。将13项质量指标的值与直肠癌工作组II和德国癌症协会工作流程制定的目标值进行比较,并与2010年德国认证肠道中心的结果进行比较。
无论病例数量多少,目标值均得到高度满足。83%的参数已完全达成,14%接近达成。在初次手术中,有12个或更多经组织学检查的淋巴结的患者比例为99.2%,新辅助放化疗后为90%。R0切除率为98.3%,仅在固有肌层平面进行TME切除的比例为2.2%。环周切缘阳性(pCRM+)率仅为5.7%。
直肠癌手术的高质量证明了该研究的理念及继续进行的合理性。