1st Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Regional Health Service, Epidemiology Unit, Veneto Region, Padua, Italy.
Int J Colorectal Dis. 2019 Dec;34(12):2129-2136. doi: 10.1007/s00384-019-03420-0. Epub 2019 Nov 14.
To assess the long-term oncological outcomes in patients with locally advanced rectal cancer who underwent neoadjuvant therapy followed by local or total mesorectal excision.
Patients with locally advanced rectal adenocarcinoma who received neoadjuvant therapy from 2005 to 2017 were evaluated. Those with major or complete clinical response underwent a full-thickness local excision. Kaplan-Meier estimates were used to evaluate overall, disease-free, and local recurrence-free survival of patients who underwent local excision (LE group) and were compared with a matched cohort of patients who underwent total mesorectal excision (TME group).
Among 252 patients who received neoadjuvant therapy for rectal cancer, 51 (20.2%) underwent a local excision. At a median follow-up of 61 months, patients who underwent local excision were stoma-free in 88.2% of cases and with rectum preserved in 78.5% of cases, respectively. The estimated 5-year local, disease-free, and overall survival was 91.8% vs 97.6% (95% CI: 79.5-96.8 vs 84.6-99.6), 86.7% vs 86.4% (95% CI: 72.5-93.9 vs 70.1-94.1), and 85% vs 90% (95% CI: 69.0-93.0% vs 75.3-96.2), in the study and matched control group, respectively. None of the differences was statistically significant.
One-fifth of patients with locally advanced rectal cancer are manageable with a rectum-sparing approach after neoadjuvant therapy. With this strategy, about 80% patients will have their rectum preserved and 90% will be without stoma at long term.
评估接受新辅助治疗后行局部或全直肠系膜切除术的局部晚期直肠癌患者的长期肿瘤学结果。
评估了 2005 年至 2017 年间接受新辅助治疗的局部晚期直肠腺癌患者。对具有主要或完全临床反应的患者进行全层局部切除。采用 Kaplan-Meier 估计评估接受局部切除（LE 组）的患者的总生存、无病生存和局部无复发生存，并与接受全直肠系膜切除术（TME 组）的匹配队列患者进行比较。
在 252 例接受新辅助治疗的直肠癌患者中，有 51 例（20.2%）行局部切除。在中位随访 61 个月时，接受局部切除的患者无造口的比例分别为 88.2%，保留直肠的比例分别为 78.5%。估计 5 年局部、无病和总生存率分别为 91.8%比 97.6%（95%CI：79.5-96.8 比 84.6-99.6）、86.7%比 86.4%（95%CI：72.5-93.9 比 70.1-94.1）和 85%比 90%（95%CI：69.0-93.0%比 75.3-96.2%），在研究组和匹配对照组中分别如此。差异均无统计学意义。
接受新辅助治疗后，约有五分之一的局部晚期直肠癌患者可采用保留直肠的方法进行治疗。采用这种策略，约 80%的患者将保留直肠，90%的患者长期无造口。
