Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Radiat Oncol. 2022 May 12;17(1):93. doi: 10.1186/s13014-022-02031-4.
In most of the views, rectal stenosis after anterior resection for rectal cancer results from pelvic radiotherapy. However, patients without receiving radiotherapy also suffer stenosis. In this study, we evaluated the factors associated with rectal stenosis after anterior rectal resection (ARR).
We conducted a retrospective study with ARR patients who underwent neoadjuvant chemoradiotherapy and the patients without radiotherapy. Patients who received watch and wait strategy with a clinical complete response after chemoradiotherapy were also included. Patients with colonoscopy follow-up were included for further analyses; 439 patients who underwent neoadjuvant chemoradiotherapy; 545 patients who received ARR without radiotherapy and 33 patients who received watch and wait strategy. Stenosis was diagnosed when a 12-mm diameter colonoscopy could not be passed through the rectum. Univariate and multivariate logistic regression analyses were performed to identify variables associated with rectal stenosis.
According to the multivariate analysis in patients receiving ARR, both protective stoma and preoperative radiotherapy affected the occurrence of stenosis, with the odds ratios (ORs) of 3.375 and 2.251, respectively. According to the multivariate analysis, a preventive ileostomy was the only factor associated with stenosis both in patients receiving preoperative radiotherapy and without radiotherapy. Non-reversal ileostomy and long time between ileostomy and restoration increased the possibility of stenosis. In 33 patients who received watch and wait strategy, only one patient (3%) experienced stenosis.
Both surgery and radiotherapy are risk factors for rectal stenosis in rectal cancer patients. Compared to preoperative radiotherapy, a protective ileostomy is a more critical factor associated with rectal stenosis.
在大多数观点中，直肠癌前切除术后直肠狭窄是由盆腔放疗引起的。然而，未接受放疗的患者也会出现狭窄。本研究评估了直肠癌前切除（ARR）后直肠狭窄的相关因素。
我们进行了一项回顾性研究，纳入接受新辅助放化疗的 ARR 患者和未接受放疗的患者。接受放化疗后临床完全缓解的观察等待策略的患者也包括在内。对接受结肠镜随访的患者进行进一步分析；共纳入 439 例接受新辅助放化疗的患者、545 例未接受放疗的 ARR 患者和 33 例接受观察等待策略的患者。当无法通过直肠插入 12mm 直径结肠镜时诊断为狭窄。进行单因素和多因素逻辑回归分析以确定与直肠狭窄相关的变量。
根据接受 ARR 的患者的多因素分析，保护性造口术和术前放疗均影响狭窄的发生，其优势比（OR）分别为 3.375 和 2.251。根据多因素分析，预防性回肠造口术是与术前放疗和未放疗患者狭窄相关的唯一因素。非反转回肠造口术和回肠造口术与重建之间的时间间隔较长增加了狭窄的可能性。在接受观察等待策略的 33 例患者中，仅有 1 例（3%）发生狭窄。
手术和放疗都是直肠癌患者直肠狭窄的危险因素。与术前放疗相比，保护性造口术是与直肠狭窄更相关的重要因素。
