新辅助治疗对因直肠癌行直肠切除术后吻合口漏内镜下真空治疗成功率的影响。
Influence of Neoadjuvant Therapy on Success of Endoscopic Vacuum Therapy in Anastomotic Leakage after Rectal Resection Because of Rectal Cancer.
作者信息
Strobel Rahel M, Wellner Julia E, Neumann Konrad, Otto Susanne D, Eschlboeck Sophie M, Seifarth Claudia, Schineis Christian H W, Beyer Katharina, Kreis Martin E, Lauscher Johannes C
机构信息
Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany.
出版信息
J Clin Med. 2024 Jul 8;13(13):3982. doi: 10.3390/jcm13133982.
For locally advanced rectal cancer, neoadjuvant therapy (NT) is an established element of therapy. Endoscopic vacuum therapy (EVT) has been a relevant treatment option for anastomotic leakage after rectal resection since 2008. The aim was to evaluate the influence of NT on the duration and success of EVT in anastomotic leakage after rectal resection for rectal cancer. This was a monocentric, retrospective cohort study including patients who underwent rectal resection with primary anastomosis because of histologically proven carcinoma of the rectum in the Department for General and Visceral Surgery of Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin over a period of ten years (2012 to 2022). Overall, 243 patients were included, of which 47 patients (19.3%) suffered from anastomotic leakage grade B with consecutive EVT. A total of 29 (61.7%) patients received NT and 18 patients (38.3%) did not. The median duration of EVT until the removal of the sponge did not differ between patients with and without NT: 24.0 days (95% CI 6.44-41.56) versus 20.0 days (95% CI 17.03-22.97); = 0.273. The median duration from insertion of EVT until complete healing was 74.0 days with NT (95% CI 10.07-137.93) versus 62.0 days without NT (95% CI 45.99-78.01); = 0.490. Treatment failure-including early persistence and late onset of recurrent anastomotic leakage-was evident in 27.6% of patients with NT versus 27.8% without NT; = 0.989. Ostomy was reversed in 19 patients (79.2%) with NT compared to 11 patients (68.8%) without NT; = 0.456. Overall, continuity was restored in 75% of patients in the long term after EVT. This trial comprised-to our knowledge-the largest study cohort to analyze the outcome of EVT in anastomotic leakage after rectal resection for rectal cancer. We conclude that neoadjuvant therapy neither prolongs EVT nor the time to healing from anastomotic leakage. The rates of treatment failure of EVT and permanent ostomy were not higher when neoadjuvant therapy was used.
对于局部晚期直肠癌，新辅助治疗（NT）是既定的治疗手段。自2008年以来，内镜下真空治疗（EVT）一直是直肠切除术后吻合口漏的一种重要治疗选择。本研究旨在评估新辅助治疗对直肠癌直肠切除术后吻合口漏患者接受EVT治疗的持续时间及治疗成功率的影响。这是一项单中心回顾性队列研究，纳入了在柏林夏里特大学医学中心本杰明·富兰克林校区普通外科和内脏外科因组织学确诊的直肠癌接受直肠切除并一期吻合的患者，研究时间跨度为十年（2012年至2022年）。总共纳入了243例患者，其中47例（19.3%）发生B级吻合口漏并接受了连续的EVT治疗。共有29例（61.7%）患者接受了新辅助治疗，18例（38.3%）患者未接受新辅助治疗。接受新辅助治疗和未接受新辅助治疗的患者，EVT直到取出海绵的中位持续时间无差异：分别为24.0天（95%CI 6.44 - 41.56）和20.0天（95%CI 17.03 - 22.97）；P = 0.273。接受新辅助治疗的患者从插入EVT到完全愈合的中位时间为74.0天（95%CI 10.07 - 137.93），未接受新辅助治疗的患者为62.0天（95%CI 45.99 - 78.01）；P = 0.490。新辅助治疗组治疗失败（包括早期持续存在和晚期复发性吻合口漏）的发生率为27.6%，未接受新辅助治疗组为27.8%；P = 0.989。新辅助治疗组19例（79.2%）患者的造口被回纳，未接受新辅助治疗组为11例（68.8%）；P = 0.456。总体而言，EVT治疗后长期有75%的患者恢复了肠道连续性。据我们所知，本试验是分析直肠癌直肠切除术后吻合口漏患者接受EVT治疗结果的最大研究队列。我们得出结论，新辅助治疗既不会延长EVT的治疗时间，也不会延长吻合口漏愈合的时间。使用新辅助治疗时，EVT的治疗失败率和永久性造口率并未更高。
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