Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon Cedex, France.
Methodological and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France.
Ann Surg Oncol. 2020 Oct;27(11):4286-4293. doi: 10.1245/s10434-020-08683-4. Epub 2020 Jun 4.
Synchronous prostate cancer (PC) and rectal cancer (RC) is a rare clinical situation. While combining curative-intent management for both cancers can be challenging, available data for guiding the multidisciplinary strategy are lacking.
Consecutive patients undergoing rectal resection for a mid-low RC with synchronous PC treated at 9 tertiary-care centers between 2008 and 2018 were included. Management strategy and data on postoperative and long-term outcomes were retrospectively analyzed.
Overall, 25 patients underwent curative-intent RC resection combined with PC management. Nine (36%), 10 (40%) and 6 (24%) patients had low-, intermediate-, and high-risk PC, respectively. Management mostly consisted of chemoradiotherapy combined in 18 patients (72%) with either TME in 12 patients or pelvic exenteration for resection of both cancers in 6 patients. Most patients underwent RC resection using a laparoscopic approach (n = 16, 64%). Anastomosis was performed in 18 patients (72%) of whom 13 received diverting ileostomy. The complete R0 resection rate was 96% (n = 24). The overall morbidity rate was 64% (n = 16) and 5 patients (20%) experienced severe surgical morbidity of which two died within 90 days of surgery after pelvic exenteration. Among patients with anastomosis, 2 patients (11%) experienced anastomotic leak requiring surgical management. After a median follow-up of 31.2 months, 3-year OS and RFS were 80.2% (CI 95% 58.8-92.2) and 68.6% (CI 95% 42.3-84.8), respectively.
This series is the largest to report that simultaneous curative-intent management of synchronous PC and RC is feasible and safe. Pelvic exenteration might be a better option when RC complete resection seems not achievable through TME.
同步前列腺癌（PC）和直肠癌（RC）是一种罕见的临床情况。虽然对两种癌症进行根治性治疗具有挑战性，但缺乏指导多学科策略的可用数据。
连续纳入 2008 年至 2018 年期间在 9 家三级保健中心接受中低位 RC 直肠切除术且同时患有 PC 的患者。回顾性分析了治疗策略以及术后和长期结果的数据。
共有 25 例患者接受了根治性 RC 切除术联合 PC 治疗。9 例（36%）、10 例（40%）和 6 例（24%）患者的 PC 风险分别为低危、中危和高危。治疗主要包括 18 例患者接受放化疗联合直肠系膜切除术（TME），6 例患者接受盆腔切除术治疗两种癌症。大多数患者采用腹腔镜（n=16，64%）进行 RC 切除术。18 例患者进行吻合术（72%），其中 13 例患者接受预防性回肠造口术。完全 R0 切除率为 96%（n=24）。总体发病率为 64%（n=16），5 例（20%）患者发生严重手术并发症，其中 2 例在接受盆腔切除术 90 天后死于术后。在进行吻合术的患者中，2 例（11%）患者发生吻合口漏，需要手术治疗。中位随访 31.2 个月后，3 年 OS 和 RFS 分别为 80.2%（95%CI，58.8%-92.2%）和 68.6%（95%CI，42.3%-84.8%）。
本系列是最大的报告，表明同时进行根治性治疗同步 PC 和 RC 是可行且安全的。当 TME 似乎无法完全切除 RC 时，盆腔切除术可能是更好的选择。
