Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
Int J Colorectal Dis. 2018 Apr;33(4):487-491. doi: 10.1007/s00384-018-2973-2. Epub 2018 Feb 21.
Among individuals who respond well to preoperative chemoradiation therapy (CRT) for ypT0-1, local excision (LE) could provide acceptable oncological outcomes. However, in ypT2 cases, the oncological safety of LE has not been determined. This study aimed to compare oncological outcomes between LE and total mesorectal excision of ypT2-stage rectal cancer after chemoradiation therapy and investigate the oncological safety of LE in these patients.
We included 351 patients who exhibited ypT2-stage rectal cancer after CRT followed by LE (n = 16 [5%]) or total mesorectal excision (TME) (n = 335 [95%]) after preoperative CRT between January 2007 and December 2013. After propensity matching, oncological outcomes between LE group and TME group were compared.
The median follow-up period was 57 months (range, 12-113 months). In the LE group, local recurrence occurred more frequently (18 vs. 4%; p = 0.034) but not distant metastases (12 vs. 11%; p = 0.690). The 5-year local recurrence-free (76 vs. 96%; p = 0.006), disease-free (64 vs. 84%; p = 0.075), and overall survival (79 vs. 93%; p = 0.045) rates of the LE group were significantly lower than those of the TME group. After propensity matching, 5-year local recurrence-free survival of the LE group was significantly lower than that of the TME group (76 vs. 97%, p = 0.029).
The high local failure rate and poor oncological outcomes for ypT2-stage rectal cancer patients who undergo CRT followed by LE cannot be justified as an indication for LE. Salvage surgery should be recommended in these patients.
对于接受术前放化疗（CRT）治疗后 ypT0-1 反应良好的患者，局部切除（LE）可以提供可接受的肿瘤学结果。然而，在 ypT2 病例中，LE 的肿瘤学安全性尚未确定。本研究旨在比较 CRT 后 ypT2 期直肠癌患者行 LE 和全直肠系膜切除术（TME）的肿瘤学结果，并探讨 LE 在这些患者中的肿瘤学安全性。
我们纳入了 351 例 CRT 后表现为 ypT2 期直肠癌的患者，其中 16 例（5%）患者接受 CRT 后行 LE（LE 组），335 例（95%）患者接受 CRT 后行 TME（TME 组）。在倾向评分匹配后，比较 LE 组和 TME 组的肿瘤学结果。
中位随访时间为 57 个月（范围，12-113 个月）。LE 组局部复发率较高（18%比 4%；p=0.034），但远处转移率无差异（12%比 11%；p=0.690）。LE 组 5 年局部无复发生存率（76%比 96%；p=0.006）、无疾病生存率（64%比 84%；p=0.075）和总生存率（79%比 93%；p=0.045）均显著低于 TME 组。在倾向评分匹配后，LE 组 5 年局部无复发生存率仍显著低于 TME 组（76%比 97%，p=0.029）。
对于接受 CRT 治疗后行 LE 的 ypT2 期直肠癌患者，局部复发率高且肿瘤学结果差，不能将其作为 LE 的适应证。这些患者应推荐进行挽救性手术。
