Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Colorectal Surgery, Karolinska University Hospital, Stockholm, Sweden.
Br J Surg. 2019 Aug;106(9):1248-1256. doi: 10.1002/bjs.11200. Epub 2019 Jun 14.
The optimal timing of surgery for rectal cancer after radiotherapy (RT) is disputed. The Stockholm III trial concluded that it was oncologically safe to delay surgery for 4-8 weeks after short-course RT (SRT), with fewer postoperative complications compared with SRT with surgery within a week. Other studies have indicated that an even shorter interval between RT and surgery (0-3 days) might be beneficial. The aim of this study was to identify the optimal interval to surgery after RT.
Patients were analysed as treated, in terms of overall treatment time (OTT), the interval from the start of RT until the day of surgery. Patients receiving SRT (5 × 5 Gy) were categorized according to OTT: 7 days (group A), 8-13 days (group B), 5-7 weeks (group C) and 8-13 weeks (group D). Patients receiving long-course RT (25 × 2 Gy) were grouped into those with an OTT of 9-11 weeks (group E) or 12-14 weeks (group F). Outcomes assessed were postoperative complications and early mortality.
A total of 810 patients were analysed (group A, 100; group B, 247; group C, 192; group D, 160; group E, 52; group F, 59). Baseline patient characteristics were similar. There were significantly more overall complications in group B than in groups C and D. Adjusted odds ratios, with B as the reference group, were: 0·72 (95 per cent c.i. 0·40 to 1·32; P = 0·289), 0·50 (0·30 to 0·84; P = 0·009) and 0·39 (0·23 to 0·65; P < 0·001) for groups A, C and D respectively. Early mortality was similar in all groups. There were no significant differences between long-course RT groups.
These results suggest that surgery should optimally be delayed for 4-12 weeks (OTT 5-13 weeks) after SRT.
直肠癌放疗（RT）后手术的最佳时机存在争议。Stockholm III 试验得出结论，短程放疗（SRT）后 4-8 周延迟手术在肿瘤学上是安全的，与 SRT 后一周内手术相比，术后并发症更少。其他研究表明，RT 与手术之间的间隔甚至更短（0-3 天）可能是有益的。本研究旨在确定 RT 后手术的最佳时机。
根据总治疗时间（OTT）和从 RT 开始到手术日的间隔，对患者进行治疗分析。接受 SRT（5×5Gy）的患者根据 OTT 分类：7 天（A 组）、8-13 天（B 组）、5-7 周（C 组）和 8-13 周（D 组）。接受长程 RT（25×2Gy）的患者分为 OTT 为 9-11 周（E 组）或 12-14 周（F 组）。评估的结果是术后并发症和早期死亡率。
共分析了 810 例患者（A 组 100 例，B 组 247 例，C 组 192 例，D 组 160 例，E 组 52 例，F 组 59 例）。基线患者特征相似。B 组的总体并发症明显多于 C 组和 D 组。调整后的优势比，以 B 组为参考组，分别为：0.72（95%可信区间 0.40 至 1.32；P=0.289）、0.50（0.30 至 0.84；P=0.009）和 0.39（0.23 至 0.65；P<0.001）。所有组的早期死亡率相似。长程 RT 组之间无显著差异。
这些结果表明，SRT 后手术最佳时机应为 4-12 周（OTT 5-13 周）。
