División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil.
División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil.
Rev Gastroenterol Mex (Engl Ed). 2020 Apr-Jun;85(2):180-189. doi: 10.1016/j.rgmx.2019.05.009. Epub 2020 Feb 11.
Surgery for distal rectal cancer (DRC) can be performed with or without sphincter preservation. The aim of the present study was to analyze the outcomes of two surgical techniques in the treatment of DRC patients: low anterior resection (LAR) and abdominoperineal resection (APR).
Patients with advanced DRC that underwent surgical treatment between 2002 and 2012 were evaluated. We compared the outcomes of the type of surgery (APR vs LAR) and analyzed the associations of survival and recurrence with the following factors: age, sex, tumor location, lymph nodes obtained, lymph node involvement, and rectal wall involvement. Patients with distant metastases were excluded.
A total of 148 patients were included, 78 of whom were females (52.7%). The mean patient age was 61.2years. Neoadjuvant chemoradiation therapy was performed in 86.5% of the patients. APR was performed on 86 (58.1%) patients, and LAR on 62 (41.9%) patients. No differences were observed between the two groups regarding clinical and oncologic characteristics. Eighty-seven (62%) patients had pT3-4 disease, and 41 patients (27.7%) had lymph node involvement. In the multivariate analysis, only poorly differentiated tumors (P=.026) and APR (P=.009) correlated with higher recurrence rates. Mean follow-up time was 32 (16-59.9) months. Overall 5-year survival was 58.1%. The 5-year survival rate was worse in patients that underwent APR (46.5%) than in the patients that underwent LAR (74.2%) (P=.009).
Patients with locally advanced DRC that underwent APR presented with a lower survival rate and a higher local recurrence rate than patients that underwent LAR. In addition, advanced T/stage, lymph node involvement, and poor tumor differentiation were associated with recurrence and a lower survival rate, regardless of the procedure.
低位直肠肿瘤（DRC）的手术可以保留括约肌或不保留括约肌。本研究的目的是分析两种手术治疗DRC 患者的结果：低位前切除术（LAR）和腹会阴切除术（APR）。
评估了 2002 年至 2012 年间接受手术治疗的晚期 DRC 患者。我们比较了手术类型（APR 与 LAR）的结果，并分析了以下因素与生存和复发的关联：年龄、性别、肿瘤位置、获得的淋巴结、淋巴结受累和直肠壁受累。排除有远处转移的患者。
共纳入 148 例患者，其中 78 例为女性（52.7%）。患者平均年龄为 61.2 岁。86.5%的患者接受了新辅助放化疗。86 例（58.1%）患者行 APR，62 例（41.9%）患者行 LAR。两组患者的临床和肿瘤学特征无差异。87 例（62%）患者有 pT3-4 疾病，41 例（27.7%）患者有淋巴结受累。多因素分析显示，只有低分化肿瘤（P=.026）和 APR（P=.009）与较高的复发率相关。平均随访时间为 32（16-59.9）个月。总 5 年生存率为 58.1%。接受 APR 的患者 5 年生存率（46.5%）低于接受 LAR 的患者（74.2%）（P=.009）。
接受 APR 的局部晚期 DRC 患者的生存率较低，局部复发率较高，而接受 LAR 的患者则较低。此外，高级 T 分期、淋巴结受累和肿瘤分化不良与复发和生存率降低有关，与手术方式无关。
