拉丁美洲直肠腺癌手术治疗的短期手术结果:来自12个国家49个中心的多中心回顾性评估

Short-term surgical outcomes of rectal adenocarcinoma surgical treatment in Latin America: a multicenter, retrospective assessment in 49 centers from 12 countries.

作者信息

Viola Malet Marcelo

机构信息

, Montevideo, Uruguay.

出版信息

Int J Colorectal Dis. 2024 Dec 23;39(1):210. doi: 10.1007/s00384-024-04763-z.

Abstract

INTRODUCTION

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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.

摘要

引言

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。

方法

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)。

结果

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。

结论

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a49f/11663813/8b96ea6cd727/384_2024_4763_Fig1_HTML.jpg

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