Buscail E, Blondeau V, Adam J-P, Pontallier A, Laurent C, Rullier E, Denost Q
Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
Colorectal Dis. 2015 Nov;17(11):973-9. doi: 10.1111/codi.12962.
The feasibility and outcome of sphincter-saving resection for rectal cancer were assessed in patients previously treated by high-dose radiotherapy for prostate cancer.
Between 2000 and 2012, 1066 patients underwent rectal excision for rectal cancer. Of these, 236 were treated by conventional radiotherapy (45 Gy) and sphincter-saving resection (Group A) and 12 were treated by external-beam radiotherapy (EBRT) for prostate cancer (70 Gy) and sphincter-saving resection (Group B) of whom five had a metachronous and seven a synchronous cancer. The end-points were surgical morbidity, pelvic sepsis, reoperation and definitive stoma.
Tumour characteristics were similar in both groups. Surgical morbidity (67% vs 25%, P = 0.004), anastomotic leakage (50% vs 10%, P = 0.001, and reoperation (50% vs 17%, P = 0.011) were significantly higher in Group B. Multivariate analyses showed that EBRT for prostate cancer was the only independent factor for anastomotic leakage (OR = 5.12; 95% CI 1.45-18.08; P = 0.011) and definitive stoma (OR = 10.56; 95% CI 3.02-39.92; P < 0.001).
High-dose radiotherapy for prostate cancer increases morbidity from rectal surgery and the risk of a permanent stoma. This suggests that a delayed coloanal anastomosis or a Hartmann procedure should be proposed as an alternative to low anterior resection in this population.
评估曾接受前列腺癌大剂量放疗的患者行直肠癌保肛手术的可行性及手术结果。
2000年至2012年间，1066例患者接受了直肠癌切除术。其中，236例接受了常规放疗（45 Gy）及保肛手术（A组），12例接受了前列腺癌外照射放疗（EBRT，70 Gy）及保肛手术（B组），其中5例为异时性癌，7例为同时性癌。观察终点为手术并发症、盆腔感染、再次手术及永久性造口。
两组患者的肿瘤特征相似。B组的手术并发症（67%对25%，P = 0.004）、吻合口漏（50%对10%，P = 0.001）及再次手术率（50%对17%，P = 0.011）显著更高。多因素分析显示，前列腺癌的EBRT是吻合口漏（OR = 5.12；95%CI 1.45 - 18.08；P = 0.011）及永久性造口（OR = 10.56；95%CI 3.02 - 39.92；P < 0.001）的唯一独立因素。
前列腺癌大剂量放疗会增加直肠癌手术的并发症发生率及永久性造口的风险。这表明，对于该人群，应建议采用延迟结肠肛管吻合术或哈特曼手术替代低位前切除术。
