Kaderi Abdeali Saif Arif, Singh Sanjay, Sharma Ankit, Kazi Mufaddal, Desouza Ashwin, Saklani Avanish
Department of Colorectal and Robotic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra India.
Indian J Surg Oncol. 2025 Apr;16(2):645-650. doi: 10.1007/s13193-024-02117-3. Epub 2024 Oct 26.
Intersphincteric resection (ISR) is being increasingly performed in metastatic rectal adenocarcinoma (with oligometastasis) patients. There has been a trend towards worse prognosis in this group. This study compares the oncological and surgical outcomes of patients with and without pre-operative oligometastasis who underwent ISR. The outcomes compared include prognostic factors like margin positivity, recurrence rates, stoma reversal rate, and surgical failure rate (defined as a combination of one or more of the aforestated factors). The demographic pattern, American Society of Anaesthesia grade (ASA), treatment received, clinical and histopathological T and N stage, grade, type of minimally invasive surgery (MIS) approach, neoadjuvant therapy, and pathological high-risk features are also studied. Patients who underwent minimally invasive ISR over 10 years at a high-volume tertiary cancer center were selected for the study. Factors used for the assessment of oncological outcomes were margin positivity (circumferential resection and distal margin), recurrence (both local and systemic), and stoma reversal rate. A descriptive and comparative analyses were performed. Four hundred and eight patients underwent minimally invasive ISR of which 25 (6.12%) patients were oligometastatic. While R0 resection was similar in both groups, higher overall recurrence (24% versus 18.5%) and low stoma reversal rate (36.8% versus 67.3%) were observed in the oligometastatic group with statistically significant differences. No local recurrence was seen in the oligometastatic group, and the difference compared to non-metastatic group was not statistically different. This study indicates that oligometastatic patients who underwent ISR experienced lower stoma reversal rates, maintaining similar local control but facing higher rates of systemic recurrence.
The online version contains supplementary material available at 10.1007/s13193-024-02117-3.
在转移性直肠腺癌（伴有寡转移）患者中，括约肌间切除术（ISR）的应用越来越多。该组患者的预后有变差的趋势。本研究比较了接受ISR的术前有无寡转移患者的肿瘤学和手术结局。比较的结局包括切缘阳性、复发率、造口回纳率和手术失败率（定义为上述一个或多个因素的组合）等预后因素。还研究了人口统计学模式、美国麻醉医师协会分级（ASA）、接受的治疗、临床和组织病理学T和N分期、分级、微创手术（MIS）方式类型、新辅助治疗以及病理高危特征。选择在一家大型三级癌症中心接受超过10年微创手术ISR的患者进行研究。用于评估肿瘤学结局的因素为切缘阳性（环周切缘和远端切缘）、复发（局部和全身）以及造口回纳率。进行了描述性和比较性分析。408例患者接受了微创手术ISR，其中25例（6.12%）患者为寡转移。虽然两组的R0切除相似，但寡转移组观察到更高的总体复发率（24%对18.5%）和更低的造口回纳率（36.8%对67.3%），差异有统计学意义。寡转移组未观察到局部复发，与非转移组相比差异无统计学意义。本研究表明，接受ISR的寡转移患者造口回纳率较低，局部控制相似，但全身复发率较高。
在线版本包含可在10.1007/s13193-024-02117-3获取的补充材料。
