Nishizaki Daisuke, Hoshino Nobuaki, Hida Koya, Nishikawa Yoshitaka, Horimatsu Takahiro, Minamiguchi Sachiko, Sakanaka Katsuyuki, Sakai Yoshiharu
Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.
J Anus Rectum Colon. 2020 Oct 29;4(4):174-180. doi: 10.23922/jarc.2020-019. eCollection 2020.
Additional surgery is considered for patients at high risk for lymph node metastasis (LNM) after local resection for early rectal cancer. Several factors are considered as indications for additional surgery, although there are currently no definitive criteria. This study aimed to clarify the need for additional surgery based on the number of risk factors for LNM and to evaluate the significance of submucosal invasion on recurrence.
Patients with early rectal cancer harboring risk factors for LNM who underwent local resection between March 2005 and December 2016 were retrospectively analyzed. Associations among the number of risk factors, prognosis, and additional treatment after local resection were investigated.
A total of 29 eligible patients were classified into the surgery (n = 10), chemoradiotherapy (n = 7), and no-additional-treatment (NAT, n = 12) groups. Among the 29 patients, 15 patients (52%) with only one risk factor did not relapse. The NAT group harbored fewer risk factors for LNM, and 8 of the 12 patients (67%) had only deep submucosal invasion. Local recurrence occurred in one patient in the chemoradiotherapy group. The estimated 5-year overall survival rates were 88.9%, 75.0%, and 81.5% in the surgery, chemoradiotherapy, and NAT groups, respectively. There were no disease-specific deaths in the overall cohort.
In the present study, no recurrence occurred in patients who did not receive additional surgery with deep submucosal invasion as the only risk factor. A multicenter investigation is necessary to confirm the safety of nonsurgical options.
对于早期直肠癌局部切除术后存在淋巴结转移（LNM）高风险的患者，会考虑进行额外手术。尽管目前尚无明确标准，但有几个因素被视为额外手术的指征。本研究旨在根据LNM风险因素的数量阐明额外手术的必要性，并评估黏膜下浸润对复发的意义。
回顾性分析2005年3月至2016年12月期间因存在LNM风险因素而接受局部切除的早期直肠癌患者。研究了风险因素数量、预后与局部切除术后额外治疗之间的关联。
总共29例符合条件的患者被分为手术组（n = 10）、放化疗组（n = 7）和无额外治疗（NAT，n = 12）组。在这29例患者中，15例（52%）仅有一个风险因素的患者未复发。NAT组的LNM风险因素较少，12例患者中有8例（67%）仅有深层黏膜下浸润。放化疗组有1例患者发生局部复发。手术组、放化疗组和NAT组的估计5年总生存率分别为88.9%、75.0%和81.5%。整个队列中无疾病特异性死亡。
在本研究中，以深层黏膜下浸润作为唯一风险因素且未接受额外手术的患者未发生复发。需要进行多中心研究以确认非手术方案的安全性。
