Chapman Brandon C, Hosokawa Patrick, Henderson William, Paniccia Alessandro, Overbey Douglas M, Messersmith Wells, Lieu Christopher, Stiegmann Greg V, Schulick Richard D, Gajdos Csaba
Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado.
J Surg Oncol. 2017 Jun;115(8):1033-1044. doi: 10.1002/jso.24613. Epub 2017 Mar 23.
Neoadjuvant chemoradiation for rectal cancer is associated with lower local recurrence rates. The objective of this study is to assess the impact of neoadjuvant therapy on perioperative complications in patients with rectal cancer.
Using the ACS-NSQIP database (2005-2012), a propensity score was used to match 3592 patients with rectal cancer receiving neoadjuvant therapy to 3592 patients undergoing surgery alone. The association between neoadjuvant chemoradiation and perioperative outcomes was evaluated.
Among all patients, overall morbidity was significantly higher in the neoadjuvant therapy group (n = 1170, 29.9%) compared to the surgery alone (n = 2350, 26.4%; P < 0.0001), but 30-day mortality was lower in the neoadjuvant group (n = 27, 0.7%) compared to the surgery alone group (n = 112, 1.3%; P = 0.0043). However, in propensity-matched patients, there was no difference in overall morbidity (OR 0.912, 95% CI 0.825-1.008) or 30-day mortality (OR 0.639, 95% CI 0.38-1.05). Overall morbidity and 30-day mortality were 29.3% (n = 1054) and 0.7% (n = 25) in the neoadjuvant group, respectively, compared to 31.3% (n = 1124) and 1.1% (n = 39) in the surgery alone group, respectively.
Patients with newly diagnosed rectal cancer could be evaluated for neoadjuvant therapy prior to surgical resection without the fear of upfront therapy causing a significant increase in perioperative complications.
直肠癌新辅助放化疗可降低局部复发率。本研究旨在评估新辅助治疗对直肠癌患者围手术期并发症的影响。
利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2005 - 2012年），采用倾向评分法将3592例接受新辅助治疗的直肠癌患者与3592例单纯接受手术的患者进行匹配。评估新辅助放化疗与围手术期结局之间的关联。
在所有患者中，新辅助治疗组（n = 1170，29.9%）的总体发病率显著高于单纯手术组（n = 2350，26.4%；P < 0.0001），但新辅助治疗组的30天死亡率（n = 27，0.7%）低于单纯手术组（n = 112，1.3%；P = 0.0043）。然而，在倾向评分匹配的患者中，总体发病率（OR 0.912，95% CI 0.825 - 1.008）或30天死亡率（OR 0.639，95% CI 0.38 - 1.05）无差异。新辅助治疗组的总体发病率和30天死亡率分别为29.3%（n = 1054）和0.7%（n = 25），而单纯手术组分别为31.3%（n = 1124）和1.1%（n = 39）。
新诊断的直肠癌患者在手术切除前可评估是否适合新辅助治疗，而无需担心前期治疗会导致围手术期并发症显著增加。
