Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia.
The University of Melbourne, Parkville, VIC, Australia.
Int J Colorectal Dis. 2024 Aug 20;39(1):135. doi: 10.1007/s00384-024-04707-7.
The aim of this study was to explore the surgical, oncological and quality of life outcomes in the setting of radical resection of colorectal carcinoma involving major nerve resection.
A systematic review of the literature was registered with the International Prospective Register for Systematic Reviews (PROSPERO) and performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify papers relating to outcomes in radical resection of colorectal cancer where major nerve resection was undertaken. Papers were identified from OVID Medline, EMBASE Classic and Web of Science encompassing all publications in English from January 2010 to June 2023. A total of 1357 nonduplicate studies were identified and screened for relevance, with six studies included in the final review.
A total of 354 major nerve resections were undertaken across the six included studies. Overall postoperative morbidity was reported at rates of up to 82%. Two studies considered nerve-resection-specific oncological outcomes, with complete pathological resection achieved at rates comparable to the wider pelvic exenteration cohort (65-68%) and without any overall survival disadvantage being conveyed by major nerve resection (p = 0.78). Two studies considered functional outcomes and noted a transient decrease in physical quality of life over the first 6 months postoperatively (p = 0.041) with significant loss to follow-up. One study considered postoperative pain in nerve resection and noted no significant increase in patient-reported pain scores associated with nerve resection (p = 0.184-0.618).
Major nerve resections in locally advanced and recurrent colorectal cancer remain understudied but with encouraging initial oncological and functional outcomes. Multicentre collaborative prospective reviews are needed to better elucidate contributors to postoperative morbidity and functional deficits and further establish interventions to ameliorate them.
本研究旨在探讨在涉及主要神经切除的结直肠癌根治性切除术中的手术、肿瘤学和生活质量结局。
本研究通过国际前瞻性系统评价注册中心（PROSPERO）进行了系统的文献综述，并遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，以确定与结直肠癌根治性切除术中进行主要神经切除相关的研究。通过 OVID Medline、EMBASE Classic 和 Web of Science 检索 2010 年 1 月至 2023 年 6 月所有以英文发表的论文，确定了相关论文。共识别出 1357 篇非重复研究，并对其相关性进行了筛选，最终有 6 篇研究纳入了综述。
在这 6 项研究中，共进行了 354 例主要神经切除术。报告的总术后发病率高达 82%。有两项研究考虑了神经切除特异性的肿瘤学结局，完全病理学切除率与更广泛的盆腔切除术队列相当（65-68%），主要神经切除并没有带来任何总体生存劣势（p=0.78）。有两项研究考虑了功能结局，并注意到术后 6 个月内身体质量的暂时下降（p=0.041），且随访率显著降低。有一项研究考虑了神经切除术后的疼痛，并未发现与神经切除相关的患者报告疼痛评分显著增加（p=0.184-0.618）。
在局部晚期和复发性结直肠癌中，主要神经切除术仍研究不足，但初始的肿瘤学和功能结局令人鼓舞。需要进行多中心合作的前瞻性研究，以更好地阐明术后发病率和功能缺陷的原因，并进一步确定改善这些问题的干预措施。
