中上段直肠癌行扩大解剖性切除联合部分直肠系膜切除术的肿瘤学结果。

Oncological outcome of wide anatomic resection with partial mesorectal excision in patients with upper and middle rectal cancer.

机构信息

Section of Colon and Rectal Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain.

Colorectal Cancer Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.

出版信息

Colorectal Dis. 2021 Jul;23(7):1837-1847. doi: 10.1111/codi.15690. Epub 2021 Jun 4.

DOI:10.1111/codi.15690

PMID:33900002

Abstract

AIM

The aim was to investigate the influence of distal resection margin and extent of mesorectal excision on long-term oncological outcomes.

METHOD

Consecutive patients with upper and middle third rectal cancer from June 2006 to February 2016 were reviewed. Patients were divided into four groups depending on the distal margin considered as a surrogate marker of the extension of mesorectal excision (Q1 ≤10 mm, Q2 11-20 mm, Q3 21-30 mm, Q4 ≥31 mm). Local-recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS) were estimated. Cox regression models were used to investigate the influence of surgical and clinicopathological variables on prognosis by adjusting for confounding factors.

RESULTS

Two hundred and eleven patients with mid (125) and upper (86) rectal cancer underwent wide mesorectal excision. The median follow-up was 48.64 months (interquartile range 28-63). 17.5% patients developed recurrence. The 5-year LRFS, DFS and OS for all patients were 93.20%, 83.89% and 80.1%, respectively, with no statistically significant differences between groups (LRFS, P = 0.601; DFS, P = 0.487; OS, P = 0.468). In the multivariable analysis the recurrences and survival were associated with the quality of the mesorectum (LRFS, hazard ratio 10.629, 95% CI 2.324-48.610, P = 0.002; DFS, hazard ratio 2.789, 95% CI 1.314-5.922, P = 0.008).

CONCLUSION

A wide anatomical resection with partial mesorectal excision and shorter distal resection margin does not jeopardize the oncological outcomes.

摘要

目的

研究远端切缘和直肠系膜全切除范围对长期肿瘤学结果的影响。

方法

回顾了 2006 年 6 月至 2016 年 2 月连续接受中上段直肠癌治疗的患者。根据远端切缘（被认为是直肠系膜全切除范围的替代标志物）分为 4 组（Q1≤10mm、Q211-20mm、Q321-30mm、Q4≥31mm）。评估局部无复发生存率（LRFS）、无病生存率（DFS）和总生存率（OS）。使用 Cox 回归模型调整混杂因素后，调查手术和临床病理变量对预后的影响。

结果

211 例中（125 例）和上段（86 例）直肠癌患者行广泛直肠系膜切除术。中位随访时间为 48.64 个月（四分位距 28-63）。17.5%的患者发生复发。所有患者的 5 年 LRFS、DFS 和 OS 分别为 93.20%、83.89%和 80.1%，各组间无统计学差异（LRFS，P=0.601；DFS，P=0.487；OS，P=0.468）。多变量分析显示，复发和生存与直肠系膜质量相关（LRFS，风险比 10.629，95%可信区间 2.324-48.610，P=0.002；DFS，风险比 2.789，95%可信区间 1.314-5.922，P=0.008）。