直肠癌手术后环周切缘阳性率高：行动呼吁。

High Rate of Positive Circumferential Resection Margins Following Rectal Cancer Surgery: A Call to Action.

作者信息

Rickles Aaron S, Dietz David W, Chang George J, Wexner Steven D, Berho Mariana E, Remzi Feza H, Greene Frederick L, Fleshman James W, Abbas Maher A, Peters Walter, Noyes Katia, Monson John R T, Fleming Fergal J

机构信息

*Department of Surgery, Surgical Health Outcomes & Research Enterprise, University of Rochester Medical Center, Rochester, NY †Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH ‡Department of Surgery, University of Texas MD Anderson Cancer Center, Houston, TX §Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Florida, Weston, FL ¶Department of Pathology and Laboratory Medicine, Cleveland Clinic Florida, Weston, FL ||Cancer Data Services, Levine Cancer Institute, Charlotte, NC **Department of Surgery, Baylor University Medical Center, Dallas, TX ††Department of Surgery, Cleveland Clinic, Abu Dhabi, United Arab Emirates ‡‡Department of Surgery, Columbia Surgical Associates, Columbia, MO.

出版信息

Ann Surg. 2015 Dec;262(6):891-8. doi: 10.1097/SLA.0000000000001391.

DOI:10.1097/SLA.0000000000001391

PMID:26473651

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5260485/

Abstract

OBJECTIVES

To identify predictors of positive circumferential resection margin following rectal cancer resection in the United States.

BACKGROUND

Positive circumferential resection margin is associated with a high rate of local recurrence and poor morbidity and mortality for rectal cancer patients. Prior study has shown poor compliance with national rectal cancer guidelines, but whether this finding is reflected in patient outcomes has yet to be shown.

METHODS

Patients who underwent resection for stage I-III rectal cancer were identified from the 2010-2011 National Cancer Database. The primary outcome was a positive circumferential resection margin. The relationship between patient, hospital, tumor, and treatment-related characteristics was analyzed using bivariate and multivariate analysis.

RESULTS

A positive circumferential resection margin was noted in 2859 (17.2%) of the 16,619 patients included. Facility location, clinical T and N stage, histologic type, tumor size, tumor grade, lymphovascular invasion, perineural invasion, type of operation, and operative approach were significant predictors of positive circumferential resection margin on multivariable analysis. Total proctectomy had nearly a 30% increased risk of positive margin compared with partial proctectomy (OR 1.293, 95%CI 1.185-1.411) and a laparoscopic approach had nearly 22% less risk of a positive circumferential resection margin compared with an open approach (OR 0.882, 95%CI 0.790-0.985).

CONCLUSIONS

Despite advances in surgical technique and multimodality therapy, rates of positive circumferential resection margin remain high in the United States. Several tumor and treatment characteristics were identified as independent risk factors, and advances in rectal cancer care are necessary to approach the outcomes seen in other countries.

摘要

目的

确定美国直肠癌切除术后环周切缘阳性的预测因素。

背景

环周切缘阳性与直肠癌患者的局部复发率高以及不良的发病率和死亡率相关。先前的研究表明对国家直肠癌指南的依从性较差，但这一发现是否反映在患者的预后中尚未得到证实。

方法

从2010 - 2011年国家癌症数据库中识别出接受I - III期直肠癌切除术的患者。主要结局是环周切缘阳性。使用双变量和多变量分析来分析患者、医院、肿瘤和治疗相关特征之间的关系。

结果

在纳入的16619例患者中，有2859例（17.2%）出现环周切缘阳性。在多变量分析中，机构位置、临床T和N分期、组织学类型、肿瘤大小、肿瘤分级、淋巴管侵犯、神经周围侵犯、手术类型和手术入路是环周切缘阳性的显著预测因素。与部分直肠切除术相比，全直肠切除术切缘阳性的风险增加近30%（OR 1.293，95%CI 1.185 - 1.411），与开放手术入路相比，腹腔镜手术入路环周切缘阳性的风险降低近22%（OR 0.882，95%CI 0.790 - 0.985）。