Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland.
World J Surg Oncol. 2021 Oct 21;19(1):308. doi: 10.1186/s12957-021-02413-0.
Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis.
We performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR.
During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy.
The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.
直肠癌是最常见的肿瘤之一，整体存活率超过 60%。然而，直肠癌根治性前切除术后吻合口局部复发（LR）仍然是一个严峻的临床问题。本研究旨在评估术后内镜监测（PES）在经直肠前切除及乙状结肠直肠吻合术后早期发现 LR 的价值。
我们对 2001 年至 2008 年期间在波兰比得哥什肿瘤中心接受手术治疗的 228 例 I-III 期直肠癌患者进行了前切除术。这些患者中有 169 例接受了围手术期放疗或放化疗。所有患者均接受了 PES，包括腹部和盆腔影像学（腹部超声、计算机断层扫描、磁共振）和临床检查。为了比较结肠镜检查与影像学技术对 LR 诊断的价值，计算了敏感性、特异性、阳性似然比、阴性似然比和受试者工作特征曲线。
在 5 年的随访期间，49 例（21%）患者出现复发；其中 15 例（6%）发生 LR，最常见于肠腔外（n=10，4%）。吻合口 LR 发生在 5 例（2%）患者中。初次手术后吻合口 LR 的平均时间为 30 个月，与其他部位相似（29 个月）。影像学和内镜均被证明是诊断吻合口 LR 的有效技术。在研究组中，接受放疗的患者内镜检查并不能提供额外的益处。
PES 对检测直肠癌根治性治疗后的 LR 有益，但并不优于影像学技术。然而，它仍然是一种有用的方法，用于对疑似或确诊的复发进行组织病理学确认。
