Fareed Ahmed M, Eldamshety Osama, Shahatto Fayz, Khater Ashraf, Kotb Sherif Z, Elzahaby Islam A, Khan Jim S
Mansoura University Oncology Center, Mansoura, Egypt.
Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Indian J Surg Oncol. 2023 Jun;14(2):331-338. doi: 10.1007/s13193-022-01674-9. Epub 2022 Nov 7.
The gold standard surgical management of curable rectal cancer is proctectomy with total mesorectal excision. Adding preoperative radiotherapy improved local control The promising results of neoadjuvant chemoradiotherapy raised the hopes for conservative, yet oncologically safe management, probably using local excision technique. This study is a prospective comparative phase III study, where 46 rectal cancer patients were recruited from patients attending Oncology Centre of Mansoura University and Queen Alexandra Hospital Portsmouth University Hospital NHS with a median follow-up 36 months. The two recruited groups were as follows: roup (A), 18 patients who underwent conventional radical surgery by TME; and group (B), 28 patients who underwent trans-anal endoscopic local excision. Patients of resectable low rectal cancer (below 10 cms from anal verge) with sphincter saving procedures were included: cT1-T3N0. The median operative time for LE was 120 min versus 300 in TME < , and median blood loss was 20 ml versus 100 ml in LE and TME, respectively ( < 0.001). Median hospital stay was 3.5 days versus 6.5 days = . No statistically significant difference in median DFS (64.2 months for LE versus 63.2 months for TME, = ) and median OS (72.9 months for LE versus 76.3 months for TME, = ). No statistically significant difference in LARS scores and QoL was observed between LE and TME ( = , = ). LE seems a good alternative to radical rectal resection in carefully selected responders to neoadjuvant therapy after thorough pre-operative evaluation, planning and patient counselling.
可治愈性直肠癌的金标准手术治疗方法是直肠切除术加全直肠系膜切除术。术前放疗可改善局部控制。新辅助放化疗的良好结果为采用局部切除技术进行保守但肿瘤学上安全的治疗带来了希望。本研究是一项前瞻性比较III期研究，从曼苏拉大学肿瘤中心和朴茨茅斯大学医院国民保健服务体系亚历山德拉女王医院的患者中招募了46例直肠癌患者，中位随访时间为36个月。招募的两组如下：A组，18例患者接受了经全直肠系膜切除术的传统根治性手术；B组，28例患者接受了经肛门内镜局部切除术。纳入了采用保留括约肌手术的可切除低位直肠癌（距肛缘10厘米以下）患者：cT1-T3N0。局部切除术的中位手术时间为120分钟，而全直肠系膜切除术为300分钟（<），局部切除术和全直肠系膜切除术的中位失血量分别为20毫升和100毫升（<0.001）。中位住院时间为3.5天，而全直肠系膜切除术为6.5天（=）。无病生存期的中位数（局部切除术为64.2个月，全直肠系膜切除术为63.2个月，=）和总生存期的中位数（局部切除术为72.9个月，全直肠系膜切除术为76.3个月，=）无统计学显著差异。局部切除术和全直肠系膜切除术之间在低位前切除综合征评分和生活质量方面未观察到统计学显著差异（=，=）。在经过全面的术前评估、规划和患者咨询后，对于新辅助治疗的精心挑选的反应者，局部切除术似乎是根治性直肠切除术的一个良好替代方案。
