Wang G, Yao X, Wu Y J, Tao K X, Gao J B
Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Prevention Medicine, School of Public Health, Guangzhou Medical University, Guangzhou 511436, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 Jun 25;27(6):615-620. doi: 10.3760/cma.j.cn441530-20230724-00013.
To study the influence of neoadjuvant chemoradiotherapy on peritoneal wound recovery after abdominoperineal resection (APR). This was a retrospective cohort study of data of 219 patients who had been pathologically diagnosed with low rectal cancer and undergone APR in the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2018 and December 2021. Of these patients, 158 had undergone surgery without any pre-surgical treatment (surgery group), 35 had undergone surgery after neoadjuvant chemotherapy (neoadjuvant chemotherapy group), and 26 had undergone surgery after neoadjuvant chemoradiotherapy (neoadjuvant chemoradiotherapy group). The primary outcome was perineal wound complications occurring within 30 days. The status of wound healing was classified into the following three levels: Level A: abnormal wound seepage that improved after wound discharge; Level B: wound infection and dehiscence; and Level C: Level B plus fever. The patients' general condition, tumor status, perianal wound healing level, and intra- and post-operative recovery were recorded. None of the study patients had any complications during surgery. The duration of surgery was 240.0 (180.0-300.0) minutes, 240.0 (225.0-270.0) minutes and 270.0 (240.0-356.2) minutes in the surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy groups, respectively (=6.508, =0.039). The rates of perineal wound complications were 34.6% (9/26) and (22.9%, 8/35)in the neoadjuvant chemoradiotherapy group and the neoadjuvant chemotherapy group, being significantly higher than that in the surgery group (10.1%, 16/158). After adjusting for patient age and sex using a logistic regression model, the risk of complications was still higher in the neoadjuvant chemoradiotherapy than in the surgery group (OR=4.6, 95%CI: 1.7-12.7; OR=2.6, 95%CI: 1.0-6.8), these differences being statistically significant (both <0.05). The duration of hospital stay was 9.5 (7.0-12.0) days, 10.0 (8.0-17.0) days and 11.5 (9.0-19.5) days for patients in the surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy groups, respectively (=0.569, =0.752). However, after adjusting for patient age and sex by using a generalized linear model, hospital stay was longer in the neoadjuvant chemoradiotherapy than in the surgery group (β [95% CI]: 4.4 [0.5-8.4], =0.028). After surgery, 155 of 219 patients required further adjuvant chemotherapy. A higher proportion of patients with than without wound complications did not attend for follow-up (32.2% [10/31] vs. 16.1% [20/124]); this difference is statistically significant (χ=4.133, =0.023). In patients with low rectal cancer, neoadjuvant radiotherapy may be associated with an increased risk of perineal wound infection and non-healing.
研究新辅助放化疗对腹会阴联合切除术（APR）后腹膜伤口愈合的影响。这是一项回顾性队列研究，收集了2018年1月至2021年12月在华中科技大学同济医学院附属协和医院经病理诊断为低位直肠癌并接受APR的219例患者的数据。其中，158例患者未接受任何术前治疗直接接受手术（手术组），35例患者接受新辅助化疗后手术（新辅助化疗组），26例患者接受新辅助放化疗后手术（新辅助放化疗组）。主要结局是30天内发生的会阴伤口并发症。伤口愈合状况分为以下三个等级：A级：伤口异常渗液，伤口引流后改善；B级：伤口感染和裂开；C级：B级加发热。记录患者的一般情况、肿瘤状况、肛周伤口愈合等级以及术中和术后恢复情况。所有研究患者手术期间均未发生任何并发症。手术组、新辅助化疗组和新辅助放化疗组的手术时长分别为240.0（180.0 - 300.0）分钟、240.0（225.0 - 270.0）分钟和270.0（240.0 - 356.2）分钟（=6.508，=0.039）。新辅助放化疗组和新辅助化疗组的会阴伤口并发症发生率分别为34.6%（9/26）和22.9%（8/35），显著高于手术组（10.1%，16/158）。使用逻辑回归模型校正患者年龄和性别后，新辅助放化疗组的并发症风险仍高于手术组（OR = 4.6，95%CI：1.7 - 12.7；OR = 2.6，95%CI：1.0 - 6.8），这些差异具有统计学意义（均<0.05）。手术组、新辅助化疗组和新辅助放化疗组患者的住院时长分别为9.5（7.0 - 12.0）天、10.0（8.0 - 17.0）天和11.5（9.0 - 19.5）天（=0.569，=0.752）。然而，使用广义线性模型校正患者年龄和性别后，新辅助放化疗组的住院时间比手术组长（β[95%CI]：4.4[0.5 - 8.4]，=0.028）。术后，219例患者中有155例需要进一步辅助化疗。有伤口并发症的患者未进行随访的比例高于无伤口并发症的患者（32.2%[10/31]对16.1%[20/124]）；这种差异具有统计学意义（χ = 4.133，=0.023）。在低位直肠癌患者中，新辅助放疗可能会增加会阴伤口感染和不愈合的风险。
