Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Republic of Korea.
Int J Colorectal Dis. 2024 Aug 20;39(1):136. doi: 10.1007/s00384-024-04708-6.
Debate persists regarding the feasibility of adopting an organ-preserving strategy as the treatment modality for clinical T2N0 rectal cancer. This study aimed to compare the outcomes of attempting organ-preserving strategies versus radical surgery in patients with clinical T2N0 mid to low rectal cancer.
Patients diagnosed with clinical T2N0 rectal cancer, with lesions located within 8 cm from the anal verge as determined by pre-treatment magnetic resonance imaging between January 2010 and December 2020 were included.
Of 119 patients, 91 and 28 were categorized into the organ-preserving attempt group and the radical surgery group, respectively. The median follow-up duration was 48.8 months (range, 0-134 months). The organ-preserving attempt group exhibited a reduced incidence of stoma formation (44.0% vs. 75.0%; p = 0.004) and a lower occurrence of grade 3 or higher surgical complications (5.8% vs. 21.4%; p = 0.025). Univariate analyses revealed no significant association between treatment strategy and 3-year local recurrence-free survival (organ-preserving attempt 87.9% vs. radical surgery 96.2%; p = 0.129), or 3-year disease-free survival (79.6% vs. 84.9%; p = 0.429). Multivariate analysis did not identify any independent prognostic factors associated with oncologic outcomes.
Compared with radical surgery, attempted organ preservation resulted in lower incidences of stoma formation and severe surgical complications, whereas oncological outcomes were comparable. Attempting organ preservation may be a safe alternative to radical surgery for clinical T2N0 mid to low rectal cancer.
关于临床 T2N0 直肠癌是否可行采用保器官策略作为治疗方式仍存在争议。本研究旨在比较对临床 T2N0 中低位直肠癌患者采用保器官策略与根治性手术的治疗效果。
纳入了 2010 年 1 月至 2020 年 12 月接受治疗前磁共振成像检查提示肿瘤距肛缘 8cm 以内的临床 T2N0 直肠癌患者。
119 例患者中，91 例患者归入保器官尝试组，28 例归入根治性手术组。中位随访时间为 48.8 个月（0-134 个月）。保器官尝试组造口形成的发生率较低（44.0%比 75.0%；p=0.004），3 级及以上手术并发症的发生率也较低（5.8%比 21.4%；p=0.025）。单因素分析显示，治疗策略与 3 年局部无复发生存率（保器官尝试组 87.9%，根治性手术组 96.2%；p=0.129）或 3 年无病生存率（79.6%比 84.9%；p=0.429）无显著相关性。多因素分析未发现与肿瘤学结果相关的独立预后因素。
与根治性手术相比，保器官尝试治疗可降低造口形成和严重手术并发症的发生率，且肿瘤学结果相当。保器官尝试治疗可能是临床 T2N0 中低位直肠癌的一种安全替代根治性手术的方法。
