François M-O, Buscail E, Vendrely V, Célérier B, Assénat V, Moreau J-B, Rullier E, Denost Q
Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France.
Department of Radiotherapy, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France.
Colorectal Dis. 2020 Nov;22(11):1545-1552. doi: 10.1111/codi.15144. Epub 2020 Jul 8.
Restorative total mesorectal excision (TME) for rectal cancer after high-dose pelvic radiotherapy for prostate cancer has been reported to provide an unacceptable rate of pelvic sepsis. In a previous publication we proposed that delayed coloanal anastomosis (DCAA) should be performed in this situation. The present study aimed to assess the feasibility and outcomes of this strategy.
Between 2000 and 2018, 1094 men were operated on for rectal cancer in our institution. All men with T2/T3 mid and low rectal cancer with preoperative radiotherapy and restorative TME were considered for this study (n = 416). Patients with external-beam high-dose radiotherapy (EBHRT) for prostate cancer (70-78 Gy) were identified and compared with patients with conventional long-course chemoradiotherapy (CRT) followed by TME. We compared our already published historical cohort (2000-2012), including arm A (CRT + TME; n = 236) and arm B (EBHRT + TME; n = 12), with our early cohort (2013-2018), including arm C (CRT + TME; n = 158) and arm D (EBHRT + TME-DCAA; n = 10). The end-points were morbidity, pelvic sepsis, reoperation rate and quality of the specimen.
Overall morbidity was not significantly different between groups. Pelvic sepsis decreased from 50% (arm B) to 10% (arm D) with the use of DCAA (P = 0.074), and was similar between arms A, C and D. Quality of the specimen was not significantly different between the four groups.
Our results suggest that TME with DCAA in patients with previous EBHRT is feasible, with the same postoperative pelvic sepsis rate as conventional CRT.
据报道，前列腺癌接受高剂量盆腔放疗后行直肠癌根治性全直肠系膜切除术（TME）会导致不可接受的盆腔感染率。在之前的一篇出版物中，我们提出在这种情况下应进行延迟结肠肛管吻合术（DCAA）。本研究旨在评估该策略的可行性和结果。
2000年至2018年期间，我院对1094名男性进行了直肠癌手术。本研究纳入了所有术前接受放疗并进行根治性TME的T2/T3中低位直肠癌男性患者（n = 416）。识别出接受前列腺癌外照射高剂量放疗（EBHRT，70 - 78 Gy）的患者，并与接受传统长疗程放化疗（CRT）后行TME的患者进行比较。我们将已发表的历史队列（2000 - 2012年），包括A组（CRT + TME；n = 236）和B组（EBHRT + TME；n = 12），与早期队列（2013 - 2018年），包括C组（CRT + TME；n = 158）和D组（EBHRT + TME - DCAA；n = 10）进行比较。终点指标为发病率、盆腔感染、再次手术率和标本质量。
各组总体发病率无显著差异。使用DCAA后，盆腔感染率从50%（B组）降至10%（D组）（P = 0.074），A组、C组和D组之间相似。四组标本质量无显著差异。
我们的结果表明，既往接受EBHRT的患者行TME联合DCAA是可行的，术后盆腔感染率与传统CRT相同。
