Madbouly Khaled M, Hussein Ahmed M, Abdelzaher Eman
Department of Surgery, University of Alexandria, El Raml Station, Alexandria, Egypt.
Department of Surgery, University of Alexandria, El Raml Station, Alexandria, Egypt.
Am J Surg. 2014 Sep;208(3):332-41. doi: 10.1016/j.amjsurg.2013.10.023. Epub 2014 Jan 17.
Mesorectal grading was reported to be a valuable prognostic factor in rectal cancer surgery. Previous studies were retrospective, and had short follow-up.
To assess the long-term influence of total mesorectal excision quality on disease recurrence in mid and low rectal cancer patients who received preoperative neoadjuvant chemoradiotherapy (CRT) and postoperative chemotherapy.
One hundred twenty-one patients with rectal cancer had either low anterior resection or abdominoperineal resection. All patients received neoadjuvant CRT and postoperative chemotherapy. Main outcome measures included TNM staging, involvement of the circumferential resection margin (ICRM), mesorectal grading, local and systemic recurrences were recorded.
Follow-up was done for at least 5 years or up to disease recurrence whatever comes first. Mean follow-up time was 59.4 months. Twenty-nine patients had abdominoperineal resection and 92 had low anterior resection. About 7.5% had positive CRM which was significantly correlated with mesorectal grading. Grade 3 mesorectal specimens were obtained in approximately 60% of patients, 27% had grade 2, and only 13% had grade 1 (poor) mesorectal specimens. Poorer mesorectal grading increased with APR and lower rectal tumors. Recurrences occurred in 20% of patients (40% in the first 2 years, 32% in the 3rd year, and 28% in the 4th and 5th years); factors affecting recurrence included lymphovascular invasion, ICRM, and N stage. Mesorectal grading was not a valuable prognostic factor for recurrence unless it resulted in ICRM. Recurrences occurred earlier with poorer mesorectal grade, yet this was not statistically significant.
Mesorectal grading is a pathologic description that reflects the quality of surgery. However, in patients who received neoadjuvant CRT and postoperative chemotherapy, grading had no long-term prognostic value regarding recurrences unless it resulted in ICRM.
据报道，直肠系膜分级是直肠癌手术中一个有价值的预后因素。以往的研究是回顾性的，且随访时间较短。
评估全直肠系膜切除质量对接受术前新辅助放化疗（CRT）和术后化疗的中低位直肠癌患者疾病复发的长期影响。
121例直肠癌患者接受了低位前切除术或腹会阴联合切除术。所有患者均接受了新辅助CRT和术后化疗。主要观察指标包括TNM分期、环周切缘受累情况（ICRM）、直肠系膜分级，记录局部和全身复发情况。
随访至少5年或直至疾病复发，以先发生者为准。平均随访时间为59.4个月。29例患者接受了腹会阴联合切除术，92例接受了低位前切除术。约7.5%的患者CRM为阳性，这与直肠系膜分级显著相关。约60%的患者获得3级直肠系膜标本，27%为2级，只有13%为1级（差）直肠系膜标本。直肠系膜分级越差，腹会阴联合切除术和低位直肠癌患者中越常见。20%的患者出现复发（前2年为40%，第3年为32%，第4年和第5年为28%）；影响复发的因素包括脉管侵犯、ICRM和N分期。除非导致ICRM，直肠系膜分级不是复发的有价值的预后因素。直肠系膜分级越差，复发越早，但这在统计学上无显著意义。
直肠系膜分级是一种反映手术质量的病理描述。然而，在接受新辅助CRT和术后化疗的患者中，除非导致ICRM，否则分级对复发没有长期预后价值。
