Division of Colorectal Surgery, Department of Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan; Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Asian J Surg. 2021 Jul;44(7):957-963. doi: 10.1016/j.asjsur.2021.01.018. Epub 2021 Feb 20.
AIMS: This study analyzed the oncological outcomes of robotic-assisted total mesorectal excision (TME) in patients with rectal cancer after neoadjuvant concurrent chemoradiotherapy (CCRT). METHODS: We enrolled 109 consecutive patients with stage II-III rectal cancer who underwent robotic-assisted TME after neoadjuvant CCRT at one hospital between July 2013 and June 2018. RESULTS: All 109 patients underwent preoperative CCRT. Of them, 37 (33.9%) achieved a pathologic complete response, and 29 (26.6%) experienced relapse, with local recurrence in 9 (8.3%) and distant metastasis in 20 (18.3%). R0 resection was performed in 104 (95.7%) patients; however, 7 (6.7%) of them developed local recurrence and 17 (16.3%) developed distant metastasis. Over a median follow-up of 42 months, the 3-year disease-free survival and overall survival rates were 73.4% and 87.2%, respectively. CONCLUSIONS: Robotic-assisted TME after neoadjuvant CCRT is safe and effective for treating patients with stage II-III rectal cancer in one institution with acceptable short-term oncological outcomes. It may be a therapeutic alternative to salvage surgery for T4 tumors invading adjacent organs, such as the bladder, prostate, and uterus.
目的:本研究分析了新辅助同步放化疗(CCRT)后接受机器人辅助全直肠系膜切除术(TME)的直肠癌患者的肿瘤学结果。
方法:我们纳入了 2013 年 7 月至 2018 年 6 月期间在一家医院接受新辅助 CCRT 后行机器人辅助 TME 的 109 例连续 II-III 期直肠癌患者。
结果:所有 109 例患者均接受了术前 CCRT。其中,37 例(33.9%)达到病理完全缓解,29 例(26.6%)出现复发,9 例(8.3%)局部复发,20 例(18.3%)远处转移。104 例(95.7%)患者行 R0 切除术,但其中 7 例(6.7%)发生局部复发,17 例(16.3%)发生远处转移。中位随访 42 个月,3 年无病生存率和总生存率分别为 73.4%和 87.2%。
结论:在一家机构中,新辅助 CCRT 后行机器人辅助 TME 治疗 II-III 期直肠癌安全有效,短期肿瘤学结果可接受。对于侵犯相邻器官(如膀胱、前列腺和子宫)的 T4 肿瘤,它可能是挽救性手术的治疗选择。
Zhonghua Wei Chang Wai Ke Za Zhi. 2020-3-25
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