局部晚期和复发性直肠癌行盆腔廓清术后结局的改变。
Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer.
出版信息
BJS Open. 2019 Mar 6;3(4):516-520. doi: 10.1002/bjs5.50153. eCollection 2019 Aug.
BACKGROUND
Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time.
METHODS
This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated.
RESULTS
Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3·5 to 12·8 per cent, and from 12·0 to 29·4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; = 0·040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62·5 to 80·0 per cent, = 0·001; high-volume: from 83·5 to 88·4 per cent, = 0·660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2·5 units ( < 0·001). R0 resection rates did not increase in either low-volume (from 51·7 to 60·4 per cent; = 0·610) or higher-volume (from 48·6 to 65·5 per cent; = 0·100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time.
CONCLUSION
Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased.
背景
盆腔切除术用于局部晚期直肠癌（LARC）和局部复发性直肠癌（LRRC）具有一定的技术挑战性，但在专业中心的应用日益增加。本研究旨在比较随时间推移的切除术结果。
方法
这是一项对 2004 年至 2015 年间在 26 家机构接受 LARC 和 LRRC 切除术的患者进行的多中心回顾性研究。评估了手术结果，包括骨切除、皮瓣重建的比例、切缘状态和输血率。还评估了高容量和低容量中心之间的结果。
结果
共有 2472 例 LARC 和 LRRC 患者在 26 家机构接受了盆腔切除术。对于 LARC，骨切除或皮瓣重建的比例从 2004 年到 2015 年分别从 3.5%增加到 12.8%和从 12.0%增加到 29.4%。术中输血量在此期间减少（中位数 4 到 2 单位；=0.040）。亚组分析显示，在低容量和高容量中心中，骨切除和皮瓣重建的比例均有所增加。低容量中心的 R0 切除率随着时间的推移显著增加，但高容量中心则没有（低容量：从 62.5%增加到 80.0%，=0.001；高容量：从 83.5%增加到 88.4%，=0.660）。对于 LRRC，骨切除或皮瓣重建率没有随时间显著变化。术中输血量中位数从 5 单位减少到 2.5 单位（<0.001）。低容量（从 51.7%增加到 60.4%；=0.610）或高容量（从 48.6%增加到 65.5%；=0.100）中心的 R0 切除率均未增加。随着时间的推移，住院时间、30 天并发症、再次干预或死亡率无显著差异。
结论
根治性切除、骨切除和皮瓣重建的比例随时间的推移而增加，而输血需求减少。
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