Department of Colorectal Surgery, DMU Digest, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris-Cité, Clichy, France.
Surgical Oncology Department, Institut Paoli Calmettes, Marseille, France.
Colorectal Dis. 2023 Oct;25(10):1973-1980. doi: 10.1111/codi.16742. Epub 2023 Sep 7.
A complete or subcomplete tumour response (CTR) is observed in 10%-25% of patients with mid/low rectal cancer after neoadjuvant chemoradiotherapy (CRT). The aim of our study was to report a multicentric French experience in local excision (LE) after CRT.
All patients who underwent LE for mid/low rectal cancer with suspected CTR after CRT, from 2006 to 2019 in seven GRECCAR centres were included. LE was considered adequate if the specimen showed a ypT0/Tis/T1R0 tumour, otherwise, a completion total mesorectal excision (TME) was discussed. Morbi-mortality, functional results and oncological outcomes were studied.
A total of 257 patients were included. LE specimens showed 36% ypT0, 4% ypTis and 19% ypT1. Thus, 108 patients (42%) had theoretical indication of completion TME, which was performed in only 42 patients. Overall, 30-day morbidity after LE was 11%, including 2% Clavien-Dindo grade III or IV complications. After completion TME, 47% described major low anterior resection syndrome versus 5% after LE alone (p < 0.001). After a mean follow-up of 4 years (range 2-6 years), the recurrence rate was 11% after LE, 32% after completion TME and 20% in patients for whom completion TME was indicated but not performed (p = 0.021).
TME remains the gold standard for mid/low rectal cancer after CRT. LE in selected patients is safe for operative and functional, but also oncological, results. However, completion TME was indicated in 42% of patients after LE, highlighting the difficulty of the preoperative diagnosis of CTR after CRT.
新辅助放化疗（CRT）后，中低位直肠癌患者有 10%-25%观察到完全或部分肿瘤缓解（CTR）。本研究的目的是报告法国七个 GRECCAR 中心 CRT 后局部切除（LE）的多中心经验。
纳入 2006 年至 2019 年间，在七个 GRECCAR 中心因疑似 CRT 而行 CRT 后 LE 治疗的中低位直肠癌患者。如果标本显示 ypT0/Tis/T1R0 肿瘤，则认为 LE 充分，否则讨论完成全直肠系膜切除术（TME）。研究了死亡率、功能结果和肿瘤学结果。
共纳入 257 例患者。LE 标本显示 36%ypT0、4%ypTis 和 19%ypT1。因此，108 例（42%）有完成 TME 的理论指征，但仅在 42 例患者中完成。总体而言，LE 后 30 天发病率为 11%，包括 2%Clavien-Dindo Ⅲ或Ⅳ级并发症。完成 TME 后，47%描述为主要低位前切除综合征，而单独行 LE 后为 5%（p<0.001）。平均随访 4 年后（范围 2-6 年），LE 后复发率为 11%，完成 TME 后为 32%，完成 TME 指征但未行 TME 的患者为 20%（p=0.021）。
TME 仍然是 CRT 后中低位直肠癌的金标准。在选择的患者中，LE 安全且具有手术和功能，同时也具有肿瘤学结果。然而，LE 后有 42%的患者需要行 TME，这突出了 CRT 后 CTR 术前诊断的困难。
