Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Am Surg. 2023 Apr;89(4):831-836. doi: 10.1177/00031348211047215. Epub 2021 Oct 11.
The ideal time interval between the completion of chemoradiotherapy and subsequent surgical resection of advanced stage rectal tumors is highly debated. Our aim is to study the effect of the time interval between the completion of chemoradiotherapy and surgical resection on postoperative and oncologic outcomes in rectal cancer.
Patients who underwent neoadjuvant chemoradiotherapy for resected locally advanced rectal tumors between 2004 and 2015 were included in this analysis. The time interval was calculated from the date of radiation completion to date of surgery. Patients were split into 2 groups based on the time interval (<8 weeks and >8 weeks). Postoperative outcomes (anastomotic leak, pathologic complete response (pCR), and readmission) and survival were assessed with multivariable logistic regression and Cox regression models while adjusting for relevant confounders.
200 patients (62% male) underwent resection with a median time interval of 8 weeks from completion of radiotherapy. On multivariable logistic regression, there was no significant increase in odds between time interval to surgery and anastomotic leak (aOR = .8 [.27-2.7], = .8), pCR (aOR = 1.2[.58-2.6] = .6), or readmission (aOR = 1.02, 95% CI:0.49-2.24, = .9). Time interval to surgery was not an independent prognostic factor for overall (HR = 1.04 CI = .4-2.65, = .9) and disease-free survival (HR = 1.2 CI = .5-2.9, = .6).
The time interval between neoadjuvant radiotherapy completion and surgical resection does not affect anastomotic leak rate, achievement of pCR, or overall and disease-free survival in patients with rectal cancer. Extended periods of time to surgical resection are relatively safe.
放化疗完成与晚期直肠肿瘤后续手术切除之间的理想时间间隔存在高度争议。我们的目的是研究放化疗完成与手术切除之间的时间间隔对直肠癌术后和肿瘤学结果的影响。
本分析纳入了 2004 年至 2015 年间接受新辅助放化疗的局部晚期直肠肿瘤患者。时间间隔从放疗完成日期计算到手术日期。根据时间间隔（<8 周和>8 周）将患者分为 2 组。术后结果（吻合口漏、病理完全缓解（pCR）和再入院）和生存情况通过多变量逻辑回归和 Cox 回归模型进行评估，同时调整了相关混杂因素。
200 例（62%为男性）患者接受了切除术，放疗完成后中位时间间隔为 8 周。多变量逻辑回归分析显示，手术时间间隔与吻合口漏（比值比[aOR] =.8 [0.27-2.7]， =.8）、pCR（aOR = 1.2 [0.58-2.6] =.6）或再入院（aOR = 1.02，95%CI：0.49-2.24， =.9）之间无显著相关性。手术时间间隔不是总生存（风险比[HR] = 1.04，CI =.4-2.65， =.9）和无病生存（HR = 1.2，CI =.5-2.9， =.6）的独立预后因素。
新辅助放疗完成与手术切除之间的时间间隔不会影响直肠癌患者的吻合口漏发生率、pCR 获得率以及总生存和无病生存。手术切除时间延长相对安全。
