对于原发性肛管直肠癌，采用初始经会阴途径进行直肠切除术的优势是什么？
What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma?
作者信息
Funahashi Kimihiko, Goto Mayu, Kaneko Tomoaki, Ushigome Mitsunori, Kagami Satoru, Koda Takamaru, Nagashima Yasuo, Yoshida Kimihiko, Miura Yasuyuki
机构信息
Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan.
出版信息
BMC Surg. 2020 Feb 3;20(1):22. doi: 10.1186/s12893-020-0683-5.
BACKGROUND
Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare short- and long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer.
METHODS
We retrospectively analyzed the short- and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group).
RESULTS
For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 min, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups.
CONCLUSION
These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.
背景
尽管保留括约肌切除术取得了进展，包括括约肌间切除术，但直肠截肢术（RA）仍然是一种重要的挽救性手术。本研究的目的是比较原发性肛管直肠癌患者采用初始会阴入路的RA与采用初始腹部入路的RA（传统腹会阴联合切除术（APR））的短期和长期结局。
方法
我们回顾性分析了48例采用初始会阴入路行RA的患者（会阴组）和21例采用初始腹部入路行RA的患者（传统组）的短期和长期结局。
结果
会阴组的手术时间比传统组短（313对388分钟，p = 0.027）。两组术后并发症发生率相似（43.8%对47.6%，p = 0.766）。会阴组的会阴伤口并发症（PWC）明显少于传统组（22.9%对57.1%，p = 0.006）。所有69例患者均接受了完整的全直肠系膜切除术，但传统组的环周切缘阳性率明显高于会阴组（0对19.0%，p = 0.011）。两组在复发率（43.8%对47.6%，p = 0.689）、5年无病生存率（63.7%对56.7%，p = 0.665）和5年总生存率（82.5%对66.2%，p = 0.323）方面无显著差异。
结论
这些数据表明，对于选择性原发性肛管直肠癌，采用初始会阴入路的RA在减少PWC和环周切缘阳性方面具有优势。有必要对该方法的优势进行进一步研究。
Zotero 插件