术前放化疗的 I-III 期直肠癌患者接受放疗和机器人辅助手术之间的时间间隔。
Time interval between the completion of radiotherapy and robotic-assisted surgery among patients with stage I-III rectal cancer undergoing preoperative chemoradiotherapy.
机构信息
Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
PLoS One. 2020 Oct 16;15(10):e0240742. doi: 10.1371/journal.pone.0240742. eCollection 2020.
BACKGROUND
This aim of this study was to evaluate the effects of time interval between the completion of radiotherapy and robotic-assisted surgery on the outcomes among patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT).
METHODS
In total, 116 patients with stage I-III rectal cancer who underwent preoperative CCRT and robotic-assisted surgery between September 2013 and February 2019 were enrolled. Patients were categorized into two groups based on the time interval: group A (10-12 weeks) and group B (≥ 12 weeks).
RESULTS
Among the 116 enrolled patients, 98 (84.5%) had middle and lower rectal cancers. Two (1.7%) patients underwent abdominoperineal resection with a sphincter preservation rate of 98.3%. Thirty-seven (31.9%) patients had a pathologic complete response (pCR). The circumferential resection margin and distal resection margin were positive in 2 (1.7%) and 1 (0.9%) patients, respectively. Therefore, the R0 resection rate was 97.4%. A total of 24 (22.4%) patients experienced postoperative relapse and 12 (10.3%) patients died; these were slightly more common in group B than in group A (28.8% vs 15.8% and 15.3% vs 5.3%, respectively; both P > 0.05); however, this difference was nonsignificant. Three-year disease-free survival (DFS) and overall survival (OS) were 75% and 89%, respectively, among all patients. Non-significant trend of favorable 3-year DFS, 3-year OS, 3-year locoregional control rate and 3-year distant metastasis control rate were observed in group A compared with group B (all P > 0.05).
CONCLUSION
Robotic-assisted surgery after a longer interval is safe and feasible for patients with rectal cancer undergoing preoperative CCRT. The present study's results suggested that the time interval of 10-12 weeks can be considered because comparable clinical and perioperative outcomes and preferable oncological outcomes were observed for interval of this length. However, future prospective randomized clinical trials are required to verify the present finding.
背景
本研究旨在评估直肠癌患者接受术前同期放化疗（CCRT）后，放疗完成与机器人辅助手术之间的时间间隔对治疗结局的影响。
方法
共纳入 2013 年 9 月至 2019 年 2 月期间接受术前 CCRT 和机器人辅助手术的 116 例 I-III 期直肠癌患者。根据时间间隔将患者分为两组：A 组（10-12 周）和 B 组（≥12 周）。
结果
在纳入的 116 例患者中，98 例（84.5%）为中低位直肠癌。2 例（1.7%）患者行腹会阴联合切除术，保肛率为 98.3%。37 例（31.9%）患者达到病理完全缓解（pCR）。2 例（1.7%）患者的环周切缘阳性，1 例（0.9%）患者的远端切缘阳性，因此 R0 切除率为 97.4%。共有 24 例（22.4%）患者术后复发，12 例（10.3%）患者死亡；B 组略高于 A 组（28.8% vs 15.8%和 15.3% vs 5.3%；均 P＞0.05），但差异无统计学意义。所有患者的 3 年无病生存率（DFS）和总生存率（OS）分别为 75%和 89%。A 组与 B 组比较，3 年 DFS、3 年 OS、3 年局部区域控制率和 3 年远处转移控制率的趋势均无显著差异（均 P＞0.05）。
结论
对于接受术前 CCRT 的直肠癌患者，放疗后较长时间间隔行机器人辅助手术是安全可行的。本研究结果表明，10-12 周的间隔时间可被考虑，因为对于这种长度的间隔，观察到了可比的临床和围手术期结局以及更好的肿瘤学结局。然而，需要未来的前瞻性随机临床试验来验证本研究结果。
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