Kondo Keisaku, Shimbo Taiju, Tanaka Keitaro, Yamamoto Masashi, Narumi Yoshifumi, Okuda Junji, Uchiyama Kazuhisa
Department of Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
Mol Clin Oncol. 2017 Jan;6(1):23-28. doi: 10.3892/mco.2016.1098. Epub 2016 Dec 1.
The present study aimed to evaluate whether preoperative chemoradiotherapy (CRT) has any adverse effects on laparoscopic surgery (LS) for locally advanced low rectal cancer (LARC). The study was performed at the Osaka Medical College Hospital, and included patients who were operated on between July 2006 and December 2013. The short-term outcomes in 156 patients who underwent surgery for LARC following CRT were evaluated, of whom 152 underwent LS. Among the patients who were followed for >40 months, 77 patients (the CRT group) were compared with 39 patients who underwent LS without CRT (the surgery-alone group) for long-term outcomes. The total number of patients who received sphincter-preserving surgery was 74%. No positive longitudinal resection margins were identified, and only 1.3% had identifiable positive circumferential resection margins. The complication rate was 14%, and no serious complications occurred. There were no significant differences between the CRT and the surgery-alone groups in terms of the 5-year relapse-free survival rate (70.1 vs. 61.5%; P=0.81) or the 5-year overall survival rate (88.3 vs. 69.2%; P=0.06). However, the 5-year local recurrence-free survival rate was significantly improved in the CRT group patients (96.1 vs. 79.5%; P=0.009). In conclusion, our results have demonstrated that LS with preoperative CRT appears to be feasible and safe, and may have beneficial effects on local recurrence.
本研究旨在评估术前放化疗（CRT）对局部进展期低位直肠癌（LARC）腹腔镜手术（LS）是否有任何不良影响。该研究在大阪医科大学医院进行，纳入了2006年7月至2013年12月期间接受手术的患者。对156例接受CRT后行LARC手术的患者的短期结局进行了评估，其中152例行LS。在随访时间超过40个月的患者中，将77例患者（CRT组）与39例未接受CRT而行LS的患者（单纯手术组）进行长期结局比较。接受保肛手术的患者总数为74%。未发现纵向切缘阳性，仅有1.3%的患者可识别环周切缘阳性。并发症发生率为14%，未发生严重并发症。CRT组与单纯手术组在5年无复发生存率（70.1%对61.5%；P = 0.81）或5年总生存率（88.3%对69.2%；P = 0.06）方面无显著差异。然而，CRT组患者的5年无局部复发生存率显著提高（96.1%对79.5%；P = 0.009）。总之，我们的结果表明，术前CRT联合LS似乎是可行且安全的，并且可能对局部复发有有益影响。
