Jäger Tarkan, Zitt Matthias, Riss Stefan, Presl Jaroslav, Schredl Philipp, Neureiter Daniel, Ramspott Jan Philipp, Tschann Peter, Brunner Walter, Nehoda Hermann, Pressl Gerd, Rohregger Klemens, Sucher Robert, Jenic Gerhard, Heuberger Andreas, Kafka-Ritsch Reinhold, Tschmelitsch Jörg, Schabl Lukas, Dornauer Isabella, Dermuth Florentina, Rokitte Karin, Singhartinger Franz, Holzinger Josef, Königsrainer Ingmar, Emmanuel Klaus, Aigner Felix
Department of Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria.
Department of Surgery, Dornbirn General Hospital, 6850 Dornbirn, Austria.
Cancers (Basel). 2025 Jan 17;17(2):283. doi: 10.3390/cancers17020283.
The treatment of locally advanced rectal cancer (LARC) has steadily progressed over the past four decades, with recent focus shifting towards total neoadjuvant therapy (TNT). This survey aims to elucidate the perceived surgical challenges faced by Austrian colorectal surgeons performing total mesorectal excision (TME), focusing on the increased complexity and surgical difficulty introduced by intensified treatment regimens.
A comprehensive survey was conducted among Austrian colorectal surgeons to explore various aspects of managing and performing TME following TNT. The survey included questions on the general management of LARC within their institutions and utilized a five-point Likert scale to assess the respondents' perceptions and experiences regarding surgical precision and post-operative morbidity associated with TNT.
A total of 31 surgeons (54% response rate) completed the survey. Regarding multidisciplinary therapy preferences, 56% of respondents preferred conventional neoadjuvant therapy regimens, with 32% favoring chemoradiotherapy and 24% opting for short-course radiotherapy, while 31% chose TNT. The majority of respondents (65%) reported quality differences in tissue dissection during TME following TNT, with 57% experiencing difficulties in identifying tissue planes and 47% noting increased tissue fragility. Increased bleeding was reported by 32% of respondents. In cases of regrowth after a watch-and-wait approach, 64% observed quality changes in tissue dissection, and 47% noted tissue fragility.
The survey results indicate that TNT impairs surgical precision due to changes in tissue quality and challenges in identifying surgical planes. Given the critical importance of surgical precision in achieving low local recurrence rates in mid-to-low LARC, these challenges could significantly impact patient outcomes. Further prospective studies are required to elucidate the extent of these effects.
在过去的四十年里，局部晚期直肠癌（LARC）的治疗取得了稳步进展，最近的重点转向了全新辅助治疗（TNT）。本调查旨在阐明奥地利结直肠外科医生在进行全直肠系膜切除术（TME）时所面临的手术挑战，重点关注强化治疗方案带来的复杂性增加和手术难度。
对奥地利结直肠外科医生进行了一项全面调查，以探讨TNT后TME的管理和实施的各个方面。该调查包括关于其所在机构内LARC的一般管理问题，并使用五点李克特量表来评估受访者对与TNT相关的手术精度和术后发病率的看法和经验。
共有31名外科医生（回复率54%）完成了调查。关于多学科治疗偏好，56%的受访者更喜欢传统的新辅助治疗方案，32%的人倾向于放化疗，24%的人选择短程放疗，而31%的人选择TNT。大多数受访者（65%）报告了TNT后TME期间组织解剖质量的差异，57%的人在识别组织层面时遇到困难，47%的人指出组织脆性增加。32%的受访者报告出血增加。在观察等待方法后的复发病例中，64%的人观察到组织解剖质量的变化，47%的人指出组织脆性。
调查结果表明，由于组织质量的变化和识别手术层面的挑战，TNT会损害手术精度。鉴于手术精度在中低位LARC实现低局部复发率方面的至关重要性，这些挑战可能会显著影响患者的预后。需要进一步的前瞻性研究来阐明这些影响的程度。
