Department of General, Visceral, Thoracic, and Transplantation Surgery, Klinikum Stuttgart, Kriegsbergstraße 60, D - 70174, Stuttgart, Germany.
Deutsches End- und Dickdarmzentrum, Mannheim, Germany.
Int J Colorectal Dis. 2021 Jan;36(1):191-194. doi: 10.1007/s00384-020-03751-3. Epub 2020 Sep 21.
Neoadjuvant chemoradiotherapy (CRT) followed by surgery is recommended for patients with diagnosed rectal cancer UICC stage II/III. The present study aimed to evaluate the accuracy of preoperative staging with focus on tumor infiltration depth and lymph node status challenging the indication of neoadjuvant CRT.
All consecutive rectal cancer patients who underwent surgical resection without neoadjuvant CRT at the Klinikum Stuttgart, Germany, between January 2015 and December 2018, were included into the study. Clinicopathologic features focusing on preoperative tumor staging and histological outcome were assessed.
A total of 100/162 patients (61.7%) underwent primary surgical rectal resection with curative intent. Among these patients, 54/100 had a correct preoperative T-staging, while 34 were overstaged and 12 understaged. With regard to the nodal status, 68 were accurately staged, while 28 were overstaged and 4 understaged. Only 4/40 perirectal lymph nodes of more than 5 mm in diameter in preoperative MRI histologically revealed to be metastasis.
For patients without neoadjuvant CRT, a tendency to preoperative overstaging was observed. Lymph node size alone did not reliably predict metastasis. According to current guidelines, 21/62 (33.9%) of these patients would have been overtreated by using CRT. On the background of relevant side effects, complications, and the limited benefit of CRT on overall survival, we suggest that primary surgical resection should be recommended more liberally for stages II and III rectal cancer.
对于确诊为 UICC 分期 II/III 期的直肠腺癌患者，推荐采用新辅助放化疗（CRT）后手术治疗。本研究旨在评估术前分期的准确性，重点是肿瘤浸润深度和淋巴结状态，这对新辅助 CRT 的适应证具有挑战性。
本研究纳入了 2015 年 1 月至 2018 年 12 月期间在德国斯图加特 Klinikum 医院接受无新辅助 CRT 的手术治疗的连续直肠腺癌患者。评估了重点为术前肿瘤分期和组织学结果的临床病理特征。
共有 162 例患者中的 100 例（61.7%）接受了根治性原发直肠切除术。在这些患者中，54/100 例患者的术前 T 分期正确，34 例患者分期过高，12 例患者分期过低。在淋巴结状态方面，68 例患者的分期准确，28 例患者分期过高，4 例患者分期过低。只有 4/40 例术前 MRI 显示直径大于 5mm 的直肠旁淋巴结存在转移。
对于未接受新辅助 CRT 的患者，存在术前分期过高的趋势。淋巴结大小单独并不能可靠地预测转移。根据目前的指南，21/62（33.9%）的患者将因使用 CRT 而过度治疗。在相关副作用、并发症和 CRT 对总生存获益有限的背景下，我们建议对于 II 期和 III 期直肠腺癌，更自由地推荐行原发手术切除。
