Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Eur J Surg Oncol. 2024 Nov;50(11):108641. doi: 10.1016/j.ejso.2024.108641. Epub 2024 Aug 24.
Despite advancements in total mesorectal excision (TME) and neoadjuvant radiotherapy, locally advanced rectal cancer remains challenging, impacting patient quality of life and mortality. This study aimed to identify the risk factors for local recurrence in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) and assess treatment strategies for recurrence.
This retrospective analysis included 682 patients diagnosed with locally advanced rectal cancer who were treated with neoadjuvant CRT and TME at Samsung Medical Center from 2008 to 2017. The exclusion criteria ensured a homogenous cohort. Clinical staging involved colonoscopies, computed tomography, magnetic resonance imaging, and digital rectal exam. Risk factors, treatment modalities, and oncological outcomes for local recurrence were evaluated.
During a median 62-month follow-up, 47 patients (6.9 %) experienced local recurrence. The risk factors for local recurrence included a positive circumferential resection margin (CRM), venous invasion, and perineural invasion. Of the 47 patients with local recurrence, 25 (53.2 %) were considered resectable. Out of these, 23 patients underwent curative resections, and 15 (65.2 %) achieved R0 resection. Patients with R0 resections exhibited superior 5-year survival rates compared to R1-2 resection or non-surgical treatment, and there was no survival difference between R1-2 resection and non-surgical treatment.
In locally advanced rectal cancer, positive CRM, venous invasion, and perineural invasion were associated with local recurrence. R0 resection showed favorable outcomes, emphasizing the importance of surveillance in high-risk patients. Treatment decisions should consider these factors for improved oncologic outcomes and quality of life.
尽管全直肠系膜切除术（TME）和新辅助放疗取得了进展，但局部进展期直肠癌仍然具有挑战性，影响患者的生活质量和死亡率。本研究旨在确定接受新辅助放化疗（CRT）治疗的局部进展期直肠癌局部复发的危险因素，并评估复发的治疗策略。
本回顾性分析纳入了 2008 年至 2017 年期间在三星医疗中心接受新辅助 CRT 和 TME 治疗的 682 例局部进展期直肠癌患者。排除标准确保了队列的同质性。临床分期包括结肠镜检查、计算机断层扫描、磁共振成像和数字直肠检查。评估了局部复发的危险因素、治疗方式和肿瘤学结果。
在中位 62 个月的随访期间，47 例（6.9%）患者发生局部复发。局部复发的危险因素包括环周切缘阳性（CRM）、静脉侵犯和神经周围侵犯。在 47 例局部复发患者中，25 例（53.2%）被认为可切除。在这些患者中，23 例接受了根治性切除术，其中 15 例（65.2%）达到了 R0 切除。R0 切除患者的 5 年生存率优于 R1-2 切除或非手术治疗，R1-2 切除与非手术治疗的生存率无差异。
在局部进展期直肠癌中，CRM 阳性、静脉侵犯和神经周围侵犯与局部复发相关。R0 切除显示出良好的结果，强调了对高危患者进行监测的重要性。治疗决策应考虑这些因素，以提高肿瘤学结果和生活质量。
