Burghgraef Thijs A, Rutgers Marieke L, Leijtens Jeroen W A, Tuyman Jurriaan B, Consten Esther C J, Hompes Roel
From the Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands.
Department of Surgery, University Medical Centre, Groningen, the Netherlands.
Ann Surg Open. 2023 Aug 23;4(3):e327. doi: 10.1097/AS9.0000000000000327. eCollection 2023 Sep.
The aim of this study was to compare the perioperative and oncological results of completion total mesorectal excision (cTME) primary total mesorectal excision (pTME).
Early-stage rectal cancer can be treated by local excision alone, which is associated with less surgical morbidity and improved functional outcomes compared with radical surgery. When high-risk histological features are present, cTME is indicated, with possible worse clinical and oncological outcomes compared to pTME.
This retrospective cohort study included all patients that underwent TME surgery for rectal cancer performed in 11 centers in the Netherlands between 2015 and 2017. After case-matching, we compared cTME with pTME. The primary outcome was major postoperative morbidity. Secondary outcomes included the rate of restorative procedures and 3-year oncological outcomes.
In total 1069 patients were included, of which 35 underwent cTME. After matching (1:2 ratio), 29 cTME and 58 pTME were analyzed. No differences were found for major morbidity (27.6% 19.0%; = 0.28) and abdominoperineal excision rate (31.0% 32.8%; = 0.85) between cTME and pTME, respectively. Local recurrence (3.4% 8.6%; = 0.43), systemic recurrence (3.4% 12.1%; = 0.25), overall survival (93.1% 94.8%; = 0.71), and disease-free survival (89.7% 81.0%; = 0.43) were comparable between cTME and pTME.
cTME is not associated with higher major morbidity, whereas the abdominoperineal excision rate and 3-year oncological outcomes are similar compared to pTME. Local excision as a diagnostic tool followed by completion surgery for early rectal cancer does not compromise outcomes and should still be considered as the treatment of early-stage rectal cancer.
本研究旨在比较根治性全直肠系膜切除术（cTME）与初次全直肠系膜切除术（pTME）的围手术期及肿瘤学结果。
早期直肠癌可仅通过局部切除进行治疗，与根治性手术相比，其手术并发症较少，功能预后更佳。当存在高危组织学特征时，需行cTME，与pTME相比，其临床及肿瘤学结果可能更差。
这项回顾性队列研究纳入了2015年至2017年期间在荷兰11个中心接受直肠癌TME手术的所有患者。病例匹配后，我们将cTME与pTME进行比较。主要结局为术后严重并发症。次要结局包括恢复性手术率及3年肿瘤学结局。
共纳入1069例患者，其中35例行cTME。匹配（1:2比例）后，分析了29例cTME和58例pTME。cTME与pTME之间在严重并发症（27.6%对19.0%；P = 0.28）及腹会阴联合切除术率（31.0%对32.8%；P = 0.85）方面均未发现差异。cTME与pTME之间的局部复发（3.4%对8.6%；P = 0.43）、全身复发（3.4%对12.1%；P = 0.25）、总生存率（93.1%对94.8%；P = 0.71）及无病生存率（89.7%对81.0%；P = 0.43）相当。
cTME与更高的严重并发症无关，而腹会阴联合切除术率及3年肿瘤学结果与pTME相似。局部切除作为早期直肠癌的诊断工具，随后行根治性手术，并不影响预后，仍应被视为早期直肠癌的治疗方法。
