现代管理策略对低位直肠癌患者临床结局的影响——一项回顾性、单中心队列研究。

Impact of Modern Management Strategies on the Clinical Outcome of Patients With Low Rectal Cancer - A Retrospective, Monocentric Cohort Study.

机构信息

Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France.

EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France.

出版信息

Anticancer Res. 2022 Apr;42(4):1949-1963. doi: 10.21873/anticanres.15673.

DOI:10.21873/anticanres.15673

PMID:35347015

Abstract

BACKGROUND

The aim of this study was to retrospectively investigate the impact of intersphincteric resection (ISR) and Enhanced Recovery After Surgery (ERAS) protocols for rectal cancer.

PATIENTS AND METHODS

Since we implemented rectal ERAS protocol and ISR in 2016, we retrospectively assessed and compared clinical, pathological and survival outcomes of two groups of patients: group 1, treated 2000-2015 (n=242); and group 2, treated 2016-2020 (n=108). Propensity score matching using nearest-neighbor method was used to match each patient of group 1 to a patient of group 2.

RESULTS

Before and after matching, the American Society of Anesthesiology score for patients in group 1 was significantly lower than in group 2 (score of 3: 9.9% vs. 25.9%, p<0.0001) as were grade I-II complications (27.7% vs. 45.4% p<0.001). Before and after matching, the quality of the mesorectum excision was significantly lower in group 1 (complete in 31% vs. 59.2% p<0.0001). After matching, 3-year overall survival for groups 1 and 2 were similar (88.2% vs. 92.6%; p=0.988).

CONCLUSION

ERAS and ISR had no negative impact on the oncological outcome of our patients and increased the preservation of bowel continuity.

摘要

背景

本研究旨在回顾性研究经括约肌间切除术（ISR）和加速康复外科（ERAS）方案对直肠癌的影响。

患者和方法

自 2016 年我们实施直肠 ERAS 方案和 ISR 以来，我们回顾性评估和比较了两组患者的临床、病理和生存结果：组 1，2000-2015 年治疗（n=242）；组 2，2016-2020 年治疗（n=108）。使用最近邻法进行倾向评分匹配，将组 1 的每位患者与组 2 的一位患者相匹配。

结果

匹配前后，组 1 的美国麻醉医师协会评分显著低于组 2（评分 3：9.9%比 25.9%，p<0.0001），I-II 级并发症发生率也显著低于组 2（27.7%比 45.4%，p<0.001）。匹配前后，组 1 的直肠系膜切除质量显著较低（完全切除率 31%比 59.2%，p<0.0001）。匹配后，组 1 和组 2 的 3 年总生存率相似（88.2%比 92.6%；p=0.988）。