Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
Colorectal Dis. 2018 Dec;20(12):1070-1077. doi: 10.1111/codi.14336. Epub 2018 Aug 14.
Involvement of the anterior mesorectal fascia (iAMRF) after neoadjuvant treatment leads to either resection of the involved organ alone [extended resection of the rectum (ERR)] or total pelvic exenteration (TPE). The purpose of this study was to compare the rate of recurrence and survival of patients undergoing ERR or TPE for iAMRF after neoadjuvant treatment. The outcome of patients who underwent total mesorectal excision after downstaging was also compared.
This was a retrospective study of primary rectal cancer patients.
Of 237 patients, 61 (21.5%) patients with nonmetastatic carcinoma rectum had iAMRF at baseline. Ten patients defaulted before completion of neoadjuvant chemoradiotherapy. After neoadjuvant chemoradiotherapy, 22 patients (43.1%) developed systemic metastases, seven patients (13.8%) were downstaged to free anterior mesorectal fascia and underwent total mesorectal excision (anterior resection/abdominoperineal resection) and the remaining 22 patients (43.1%) had persistent iAMRF. Thirteen patients with persistent iAMRF underwent ERR, whereas nine patients underwent TPE. The median duration of hospital stay in the TPE group was 13 days (10-26), whereas it was 7 days (5-21) in the ERR group. A clear circumferential resection margin, R0 resection, was achieved in all patients with TPE and ERR. After a median follow-up of 31.6 months, five patients with TPE (55.6%), four patients with ERR (30.7%) and three patients in the downstaged group (42.9%) developed systemic recurrence. None of the patients with TPE and the downstaged group developed local recurrence, whereas three patients with ERR (23.1%) developed local recurrence. Median disease-free survival was 12.3 months in the TPE group, 18.9 months in the ERR group and 10.6 months in the downstaged group, whereas mean overall survival was 36.2, 32.8 and 27.9 months, respectively.
Although there is no significant difference in the overall survival and disease-free survival, ERR is associated with a high risk of local recurrence compared to TPE and the downstaged group.
新辅助治疗后累及前中直肠筋膜（iAMRF）可导致受累器官单独切除[扩大直肠切除术（ERR）]或全盆腔切除术（TPE）。本研究旨在比较新辅助治疗后 iAMRF 行 ERR 或 TPE 治疗的患者的复发率和生存率。还比较了降期后行全直肠系膜切除术的患者的结果。
这是一项原发性直肠癌患者的回顾性研究。
在 237 例患者中，61 例（21.5%）非转移性直肠癌患者基线时有 iAMRF。10 例患者在新辅助放化疗完成前失访。新辅助放化疗后，22 例（43.1%）患者发生全身转移，7 例（13.8%）降期至无前中直肠筋膜，并接受全直肠系膜切除术（前切除术/腹会阴切除术），其余 22 例（43.1%）患者仍有 iAMRF。13 例持续 iAMRF 的患者行 ERR，9 例行 TPE。TPE 组的中位住院时间为 13 天（10-26 天），ERR 组为 7 天（5-21 天）。所有 TPE 和 ERR 患者均获得清晰的环周切缘、R0 切除。中位随访 31.6 个月后，TPE 组 5 例（55.6%）、ERR 组 4 例（30.7%）和降期组 3 例（42.9%）患者发生全身复发。TPE 和降期组均无局部复发，而 ERR 组 3 例（23.1%）患者发生局部复发。TPE 组无病生存期为 12.3 个月，ERR 组为 18.9 个月，降期组为 10.6 个月，而总生存期分别为 36.2、32.8 和 27.9 个月。
尽管总生存率和无病生存率无显著差异，但 ERR 与 TPE 和降期组相比，局部复发风险较高。
