Grosek Jan, Velenik Vaneja, Edhemovic Ibrahim, Omejc Mirko
Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Radiol Oncol. 2016 May 24;51(2):169-177. doi: 10.1515/raon-2016-0030. eCollection 2017 Jun.
Low recurrence rates and long term survival are the main therapeutic goals of rectal cancer surgery. Complete, margin- negative resection confers the greatest chance for a cure. The aim of our study was to determine whether the length of the distal resection margin was associated with local recurrence rate and long- term survival.
One hundred and nine patients, who underwent sphincter-preserving resection for locally advanced rectal cancer after preoperative chemoradiotherapy between 2006 and 2010 in two tertiary referral centres were included in the study. Distal resection margin lengths were measured on formalin-fixed, pinned specimens. Characteristics of patients with distal resection margin < 8 mm (Group I, n = 27), 8-20 mm (Group II, n = 31) and > 20 mm (Group III, n = 51) were retrospectively analysed and compared. Median (range) follow-up time in Group I was 89 (51-111), in Group II 83 (57-111) and in Group III 80 (45-116) months (p = 0.326), respectively.
Univariate survival analysis showed that distal resection margin length was not statistically significantly associated with overall survival or local recurrence rate (p > 0.05). In a multiple Cox regression analysis, after adjusting for pathologic T and N stage (yT, yN), distal resection margin length was still not statistically significantly associated with overall survival.
Our study shows that close distal resection margins can be accepted as oncologically safe for sphincter-preserving rectal resections after preoperative chemoradiotherapy.
低复发率和长期生存是直肠癌手术的主要治疗目标。完整的、切缘阴性的切除提供了最大的治愈机会。我们研究的目的是确定远端切缘长度是否与局部复发率和长期生存相关。
纳入2006年至2010年在两个三级转诊中心接受术前放化疗后行保留括约肌直肠癌切除术的109例患者。在福尔马林固定、钉住的标本上测量远端切缘长度。对远端切缘<8mm(I组,n = 27)、8 - 20mm(II组,n = 31)和>20mm(III组,n = 51)的患者特征进行回顾性分析和比较。I组的中位(范围)随访时间为89(51 - 111)个月,II组为83(57 - 111)个月,III组为80(45 - 116)个月(p = 0.326)。
单因素生存分析显示,远端切缘长度与总生存或局部复发率无统计学显著相关性(p>0.05)。在多因素Cox回归分析中,校正病理T和N分期(yT,yN)后,远端切缘长度仍与总生存无统计学显著相关性。
我们的研究表明,对于术前放化疗后行保留括约肌直肠癌切除术,切缘较近在肿瘤学上可被认为是安全的。