Morohashi Hajime, Sakamoto Yoshiyuki, Miura Takuya, Kagiya Takuji, Sato Kentaro, Tsutsumi Shinji, Takahashi Seiji, Nakayama Yoshihito, Tamba Hiroaki, Matsumoto Shuntaro, Kasai Daiki, Hakamada Kenichi
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori, 036-8562, Japan.
Hirosaki National Hospital, Hirosaki, Japan.
BMC Gastroenterol. 2024 Dec 18;24(1):456. doi: 10.1186/s12876-024-03549-5.
Chemoradiotherapy (CRT) for rectal cancer is limited by its harmful side effects and its insufficient benefit on lateral lymph node metastases. The purpose of this study was to evaluate the long-term outcomes of S-1 and oxaliplatin with total mesorectal excision (TME) and lateral lymph node dissection (LLND) without radiation for rectal cancer.
The inclusion criteria were patients with stage II or III rectal cancer located within 10 cm from the anal verge. Fifty-two patients who underwent neoadjuvant chemotherapy (NAC) followed by TME and LLND were evaluated. The primary endpoint was the 3-year local recurrence. The secondary endpoints were the 3-year rates of relapse-free survival and overall survival. Expected post-NAC and surgical outcomes were prospectively analyzed.
The overall recurrence rate was 15.4%, with eight patients developing distant recurrences. The local recurrence rate was 7.7% (n = 4). Among the 4 patients with local recurrence, 3 (5.8%) patients had central pelvis recurrence, and 1 (1.9%) patient had lateral pelvic recurrence. The 3-year survival rate was 98.1%, and the 3-year relapse-free survival rate was 84.6%. The risk factors for local recurrence were mucinous carcinoma (p = 0.016) and a positive resection margin (p = 0.009). Pathological mesorectal lymph node metastasis and local recurrence were independent risk factors for poor survival.
Although preoperative chemotherapy and TME with LLND are sufficient to control local recurrence, some cases will require more aggressive chemotherapy with radiation therapy.
直肠癌的放化疗受其有害副作用及其对侧方淋巴结转移获益不足的限制。本研究的目的是评估S-1和奥沙利铂联合全直肠系膜切除术（TME）及侧方淋巴结清扫术（LLND）且不放疗治疗直肠癌的长期疗效。
纳入标准为距肛缘10 cm以内的II期或III期直肠癌患者。对52例行新辅助化疗（NAC）后接受TME和LLND的患者进行评估。主要终点是3年局部复发率。次要终点是3年无复发生存率和总生存率。对NAC后及手术预期结果进行前瞻性分析。
总复发率为15.4%，8例患者发生远处复发。局部复发率为7.7%（n = 4）。在4例局部复发患者中，3例（5.8%）为盆腔中央复发，1例（1.9%）为盆腔侧方复发。3年生存率为98.1%，3年无复发生存率为84.6%。局部复发的危险因素为黏液腺癌（p = 0.016）和切缘阳性（p = 0.009）。病理直肠系膜淋巴结转移和局部复发是生存不良的独立危险因素。
尽管术前化疗及TME联合LLND足以控制局部复发，但部分病例仍需要更积极的放化疗。
