Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK.
Imperial College London, London, UK.
Colorectal Dis. 2017 Feb;19(2):139-147. doi: 10.1111/codi.13477.
The study aimed to establish the oncological outcome of patients who opted for close surveillance with or without adjuvant chemoradiotherapy rather than radical surgery after local excision (LE) of early rectal cancer.
The Royal Marsden Hospital Rectal Cancer database was used to identify rectal cancer patients treated by primary LE from 2006 to 2015. All patients were entered in an intensive surveillance programme.
Twenty-eight of 34 analysed patients had a high or very high risk of residual disease predicted by adverse histopathological features for which the recommendation had been radical surgery. Eighteen (52%) of the 34 had received radiotherapy following LE. Three-year disease-free survival for the 34 patients was 85% (95% CI 78.8%-91.2%) and overall survival was 100%. Twenty-two of 24 patients with a low tumour which would have required total rectal excision have so far avoided radical surgery and remain disease free at a median follow-up of 3.2 years.
The findings suggest that with modern MRI and clinical surveillance radical surgery can be avoided in patients following initial LE of a histopathologically defined high risk early rectal cancer. These findings are comparable with those obtained after major radical resection and warrant further prospective investigation as a treatment arm in larger prospective trials.
本研究旨在评估局部切除（LE）早期直肠癌后选择密切监测或联合辅助放化疗而非根治性手术治疗患者的肿瘤学结局。
使用皇家马斯登医院直肠癌数据库，从 2006 年至 2015 年，确定接受 LE 治疗的直肠癌患者。所有患者均纳入强化监测计划。
34 例分析患者中，28 例因不良组织病理学特征预测存在残留疾病高风险或极高风险，推荐行根治性手术。34 例中有 18 例（52%）在 LE 后接受了放疗。34 例患者的 3 年无疾病生存率为 85%（95%CI 78.8%-91.2%），总生存率为 100%。24 例肿瘤低危患者（需要全直肠切除）中，22 例患者目前已避免了根治性手术，且在中位随访 3.2 年时无疾病生存。
这些发现表明，对于经组织病理学明确的高危早期直肠癌初始 LE 后患者，通过现代 MRI 和临床监测，可以避免根治性手术。这些发现与根治性切除术后获得的结果相当，需要进一步前瞻性研究，作为更大前瞻性试验中的一种治疗手段。
