短程全新辅助治疗、长程放化疗及 upfront 手术对全直肠系膜切除技术难度的影响：一项术中视角的观察性研究

The impact of short-course total neoadjuvant therapy, long-course chemoradiotherapy, and upfront surgery on the technical difficulty of total mesorectal excision: an observational study with an intraoperative perspective.

作者信息

Chong Cheryl Xi-Zi, Koh Frederick H, Tan Hui-Lin, Sivarajah Sharmini Su, Ng Jia-Lin, Ho Leonard Ming-Li, Aw Darius Kang-Lie, Koo Wen-Hsin, Han Shuting, Koo Si-Lin, Yip Connie Siew-Poh, Wang Fu-Qiang, Foo Fung-Joon, Tan Winson Jianhong

机构信息

Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.

Department of Medical Oncology, National Cancer Centre Singapore, Singapore.

出版信息

Ann Coloproctol. 2024 Oct;40(5):451-458. doi: 10.3393/ac.2023.00899.0128. Epub 2024 Sep 19.

DOI:10.3393/ac.2023.00899.0128

PMID:39477330

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11532385/

Abstract

PURPOSE

Total neoadjuvant therapy (TNT) is becoming the standard of care for locally advanced rectal cancer. However, surgery is deferred for months after completion, which may lead to fibrosis and increased surgical difficulty. The aim of this study was to assess whether TNT (TNT-RAPIDO) is associated with increased difficulty of total mesorectal excision (TME) compared with long-course chemoradiotherapy (LCRT) and upfront surgery.

METHODS

Twelve laparoscopic videos of low anterior resection with TME for rectal cancer were prospectively collected from January 2020 to October 2021, with 4 videos in each arm. Seven colorectal surgeons assessed the videos independently, graded the difficulty of TME using a visual analog scale and attempted to identify which category the videos belonged to.

RESULTS

The median age was 67 years, and 10 patients were male. The median interval to surgery from radiotherapy was 13 weeks in the LCRT group and 24 weeks in the TNT-RAPIDO group. There was no significant difference in the visual analog scale for difficulty in TME between the 3 groups (LCRT, 3.2; TNT-RAPIDO, 4.6; upfront, 4.1; P=0.12). A subgroup analysis showed similar difficulty between groups (LCRT 3.2 vs. TNT-RAPIDO 4.6, P=0.05; TNT-RAPIDO 4.6 vs. upfront 4.1, P=0.54). During video assessments, surgeons correctly identified the prior treatment modality in 42% of the cases. TNT-RAPIDO videos had the highest recognition rate (71%), significantly outperforming both LCRT (29%) and upfront surgery (25%, P=0.01).

CONCLUSION

TNT does not appear to increase the surgical difficulty of TME.

摘要

目的

全新辅助治疗（TNT）正成为局部晚期直肠癌的标准治疗方案。然而，治疗完成后手术会推迟数月，这可能导致纤维化并增加手术难度。本研究的目的是评估与长程放化疗（LCRT）和直接手术相比，TNT（TNT-RAPIDO）是否会增加全直肠系膜切除术（TME）的难度。

方法

前瞻性收集了2020年1月至2021年10月期间12例直肠癌TME低位前切除术的腹腔镜视频，每组4个视频。7位结直肠外科医生独立评估这些视频，使用视觉模拟量表对TME的难度进行分级，并试图确定视频所属类别。

结果

中位年龄为67岁，10例患者为男性。LCRT组放疗至手术的中位间隔时间为13周，TNT-RAPIDO组为24周。三组之间TME难度的视觉模拟量表评分无显著差异（LCRT组为3.2；TNT-RAPIDO组为4.6；直接手术组为4.1；P = 0.12）。亚组分析显示各组之间难度相似（LCRT组3.2 vs. TNT-RAPIDO组4.6，P = 0.05；TNT-RAPIDO组4.6 vs. 直接手术组4.1，P = 0.54）。在视频评估过程中，外科医生在42%的病例中正确识别了先前的治疗方式。TNT-RAPIDO视频的识别率最高（71%），显著优于LCRT组（29%）和直接手术组（25%，P = 0.01）。