Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fuzhou, China.
Cancer Med. 2024 Oct;13(19):e70307. doi: 10.1002/cam4.70307.
The hiatal ligament, as the anatomical landmark for the completion of total mesorectal excision (TME) for ultra-low rectal cancer, represents a continuation of the longitudinal muscle of the rectum. It receives vascular supply from the median sacral artery and contains lymphatic vessels. In cases where ultra-low rectal cancer is located in the posterior rectal wall, the hiatal ligament may theoretically serve as an anatomical region susceptible to direct tumor cell spread or distant metastasis.
To evaluate the effect of circumferential tumor location (CTL) on postoperative survival of low rectal cancer and to determine the effect of total hiatal ligament excision (THLE) on the prognosis of patients with posterior rectal cancer.
Patients with ultra-low rectal cancer who underwent laparoscopic surgery between March 2014 and October 2021 were enrolled in this study. Propensity score matching (PSM) analysis was used to compare the clinicopathological characteristics and prognosis of patients in the posterior group and the non-posterior group. Prognostic factors were identified using COX regression. PSM analysis was also used in the posterior tumor subgroup to compare the clinicopathological characteristics and prognosis of patients in the hiatal ligament traditional transection (HLTT) and THLE groups.
After PSM, OS, and DFS were comparable between the posterior and non-posterior groups. Similarly, no difference was noted in the local recurrence rate between the two groups (p = 0.23). The prognosis of ultra-low rectal cancer was not affected by CTL. However, the local recurrence rate was significantly lower in the THLE group compared with the HLTT group (p = 0.023). Multivariate analysis of the posterior group identified CRM, TNM stage III, and HLTT as independent risk factors for local recurrence-free survival.
CTL is not a prognostic risk factor for low rectal cancer. In posterior wall tumors, THLE significantly reduces the local recurrence rate for low rectal cancer.
裂孔韧带作为完成超低位直肠癌全直肠系膜切除术（TME）的解剖学标志，是直肠纵行肌的延续。它接受来自正中骶动脉的血管供应，并包含淋巴管。在超低位直肠癌位于直肠后壁的情况下，裂孔韧带理论上可能是直接肿瘤细胞扩散或远处转移的解剖区域。
评估环周肿瘤位置（CTL）对低位直肠癌术后生存的影响，并确定全裂孔韧带切除（THLE）对后壁直肠癌患者预后的影响。
本研究纳入了 2014 年 3 月至 2021 年 10 月间接受腹腔镜手术的超低位直肠癌患者。采用倾向评分匹配（PSM）分析比较后组和非后组患者的临床病理特征和预后。使用 COX 回归确定预后因素。在后壁肿瘤亚组中也进行了 PSM 分析，比较裂孔韧带传统横断（HLTT）和 THLE 组患者的临床病理特征和预后。
PSM 后，后组和非后组的 OS 和 DFS 无差异。两组局部复发率也无差异（p=0.23）。CTL 对超低位直肠癌的预后没有影响。然而，THLE 组的局部复发率明显低于 HLTT 组（p=0.023）。对后组的多因素分析确定 CRM、TNM 分期 III 期和 HLTT 为局部无复发生存的独立危险因素。
CTL 不是低位直肠癌的预后危险因素。在后壁肿瘤中，THLE 显著降低了低位直肠癌的局部复发率。
