局部切除与全直肠系膜切除治疗新辅助放化疗后临床完全或接近完全缓解的直肠癌患者。
Local excision versus total mesorectal excision for rectal cancer patients with clinical complete or near-complete response after neoadjuvant chemoradiotherapy.
机构信息
Department of Anorectal Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
Department of Critical Care Medicine, Jinling Hospital of Medical School of Nanjing University, Nanjing, 210016, Jiangsu, China.
出版信息
Int J Colorectal Dis. 2024 Oct 8;39(1):157. doi: 10.1007/s00384-024-04720-w.
PURPOSE
Local excision is an effective approach for managing rectal cancer exhibiting substantial regression after neoadjuvant chemoradiotherapy. The purpose of this study is to compare the outcomes between local excision and total mesorectal excision in rectal cancer patients achieving clinical complete or near-complete response after neoadjuvant chemoradiotherapy.
METHODS
This is a retrospective cohort study that includes a consecutive series of rectal cancer patients who responded well to neoadjuvant chemoradiotherapy followed by surgery. A total of 180 rectal cancer patients at a single institution during a 12-year period are included. The main outcomes include short-term outcomes, oncological outcomes, and functional outcomes between the two groups.
RESULTS
A total of 180 patients were included in the study. Sixty-one (33.9%) received local excision and 119 (66.1%) received total mesorectal excision. The baseline characteristics were generally balanced between the two groups. The local excision group demonstrated a significantly shorter operative time, less blood loss, and shorter hospital stay (p < 0.001). 3-year overall survival rates were 97.5% (95% CI, 0.93-1.00) and 95.5% (95% CI, 0.91-1.00) between the two groups (p = 0.38). The local excision group exhibited significantly higher 3-year local recurrence rates 15.7% (95% CI, 0.74-0.97) vs 4.2% (95% CI, 0.92-1.00) (p = 0.017), yet lower 3-year distant metastasis rates 9.6% (95% CI, 0.82-1.00) vs 12.6% (95% CI, 0.81-0.94) (p = 0.33) and lower 3-year disease-free survival rates 76.8% (95% CI, 0.64-0.92) vs 84.7% (95% CI, 0.78-0.92) (p = 0.56) comparing with the total mesorectal excision group. The local excision group demonstrated significantly better functional outcomes compared with the total mesorectal excision group (p < 0.001).
CONCLUSION
Patients who achieve either clinical complete or near-complete response after neoadjuvant chemoradiotherapy are suitable candidates for local excision. The local excision group demonstrated superior short-term and functional outcomes, and the oncological outcomes were not compromised.
目的
新辅助放化疗后明显消退的直肠癌患者，局部切除术是一种有效的治疗方法。本研究旨在比较新辅助放化疗后获得临床完全或接近完全缓解的直肠癌患者接受局部切除术与全直肠系膜切除术的治疗效果。
方法
这是一项回顾性队列研究，纳入了在 12 年期间于单机构接受新辅助放化疗后行手术治疗的连续系列直肠癌患者。共纳入 180 例直肠癌患者。主要结局包括两组之间的短期结局、肿瘤学结局和功能结局。
结果
共纳入 180 例患者。61 例（33.9%）接受局部切除术，119 例（66.1%）接受全直肠系膜切除术。两组患者的基线特征基本平衡。局部切除术组的手术时间更短、出血量更少、住院时间更短（p<0.001）。两组患者的 3 年总生存率分别为 97.5%（95%CI，0.93-1.00）和 95.5%（95%CI，0.91-1.00）（p=0.38）。局部切除术组的 3 年局部复发率显著较高（15.7%，95%CI，0.74-0.97），而远处转移率显著较低（9.6%，95%CI，0.82-1.00）（p=0.017），3 年无病生存率也显著较低（76.8%，95%CI，0.64-0.92），而远处转移率显著较低（9.6%，95%CI，0.82-1.00）（p=0.33）。与全直肠系膜切除术组相比，局部切除术组的功能结局显著更好（p<0.001）。
结论
新辅助放化疗后获得临床完全或接近完全缓解的患者适合行局部切除术。局部切除术组的短期和功能结局更好，肿瘤学结局不受影响。
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