Viola Malet Marcelo
, Montevideo, Uruguay.
Int J Colorectal Dis. 2024 Dec 23;39(1):210. doi: 10.1007/s00384-024-04763-z.
Rectal cancer is a prevalent disease that requires multidisciplinary management. Results of treatment of patients suffering from this malignancy in Latin America have been scarcely reported before.
A retrospective, multicenter study was conducted to report preoperative and operative characteristics of patients intervened for rectal cancer in centers from Latin America during 2015-2022, and the short-term results of treatment were analyzed. The study was open to any center receiving rectal cancer patients, irrespective of volume. The main study outcome was 30-day postoperative complications including any deviation from the normal postoperative course (Clavien Dindo I to V).
A total of 2044 patients from 49 centers in 12 Latin American countries were included, with a mean age of 63 years. Twenty-five percent of patients were operated in low-volume centers. Twenty-nine percent of patients had a tumor located in the low rectum, and only 53% of patients had preoperative MRI for local staging. A total of 1052 patients (52%) received neoadjuvant therapy before surgery. Eighty-six percent of patients were operated by a specialized colorectal surgeon, and 31% of patients were intervened using a conventional approach. A total of 29.9% of patients presented a postoperative complication. The anastomotic leak rate was 8.9%. Fifty-eight percent of pathology reports had less than 12 lymph nodes harvested, and 22.9% of reports did not include mesorectal quality. In the multivariate analysis, neoadjuvant therapy (OR: 1.44, p-value: 0.023), urgent procedures (OR: 3.73, p-value: 0.049), intraoperative complications (OR: 2.21, p-value: 0.046), advanced tumors (OR: 1.39, p-value: 0.036), and prolonged surgery (OR: 1.74, p-value: 0.004) were found to be independently related to suffering postoperative complications.
This study includes information about the approach and results of rectal cancer management in Latin America at a large scale. In the future, this information can be used as a bridge to identify areas of improvement among rectal cancer patients' treatment in the region.
直肠癌是一种常见疾病，需要多学科管理。此前，拉丁美洲地区罹患这种恶性肿瘤患者的治疗结果鲜有报道。
开展了一项回顾性多中心研究，以报告2015年至2022年期间拉丁美洲各中心接受直肠癌干预患者的术前和手术特征，并分析治疗的短期结果。该研究对任何接收直肠癌患者的中心开放，无论其规模大小。主要研究结果是术后30天并发症，包括任何偏离正常术后病程的情况（Clavien Dindo I至V级）。
纳入了来自拉丁美洲12个国家49个中心的2044例患者，平均年龄63岁。25%的患者在小容量中心接受手术。29%的患者肿瘤位于直肠下段，仅有53%的患者术前行MRI进行局部分期。共有1052例患者（52%）在手术前接受了新辅助治疗。86%的患者由专业结直肠外科医生进行手术，31%的患者采用传统方法进行干预。共有29.9%的患者出现术后并发症。吻合口漏发生率为8.9%。58%的病理报告所获取的淋巴结少于12枚，22.9%的报告未提及直肠系膜质量。在多变量分析中，发现新辅助治疗（比值比：1.44，p值：0.023）、急诊手术（比值比：3.73，p值：0.049）、术中并发症（比值比：2.21，p值：0.分：0.046）、晚期肿瘤（比值比：1.39，p值：0.036）和手术时间延长（比值比：1.74，p值：0.004）与发生术后并发症独立相关。
本研究大规模纳入了拉丁美洲地区直肠癌治疗方法和结果的信息。未来，这些信息可作为桥梁，用于确定该地区直肠癌患者治疗中有待改进的领域。
