Shadmanov Niyaz, Aliyev Vusal, Bakır Barıs, Goksel Suha, Asoglu Oktar
Bogazici Academy for Clinical Sciences, Acisu Street, Apart. No 16, 34357/Beşiktaş, Istanbul, Turkey.
Department of General Surgery, Alibey Hospital, Istanbul, Turkey.
J Gastrointest Cancer. 2025 Aug 24;56(1):177. doi: 10.1007/s12029-025-01303-y.
This study aims to evaluate how advancements in surgical technology and evolving neoadjuvant treatment (NAT) protocols have influenced clinical, pathological, and long-term oncological outcomes in patients with locally advanced distal rectal cancer (LADRC). Particular emphasis is placed on how the evolving practice of a single high-volume colorectal surgeon has mirrored these developments over a 23-year period.
This retrospective cohort included 561 patients with LADRC who underwent NAT between 2001 and 2024. Patients were stratified into two groups based on the year 2013, which marked the institutional adoption of robotic surgery, high-resolution 3-Tesla MRI, and the formal implementation of the Watch-and-Wait (W&W) strategy: Group I (2001-2012) and Group II (2013-2024).
The median follow-up duration was significantly longer in Group 1 (191 ± 2.29 months) compared to Group 2 (71 ± 2.81 months). Local recurrence (LR) occurred in 11.6% of patients in Group 1 and 6.9% in Group 2 (p = 0.107), while distant metastasis (DM) was observed in 15.5% and 10.6%, respectively (p = 0.178) (Fig. 2). Disease-free survival (DFS) at 5 years was 67.4% (95% CI: 58.6-74.8) in Group 1 and 80.1% (95% CI: 75.6-83.8) in Group 2 (p = 0.003). At 10 years, DFS was 65.2% (95% CI: 58.6-74.8) and 79.4% (95% CI: 74.7-83.3) in Groups 1 and 2, respectively (p = 0.006). Similarly, overall survival (OS) at 5 years was 78.0% (95% CI: 67.6-82.4) in Group 1 and 91.7% (95% CI: 87.9-93.3) in Group 2 (p < 0.001). At 10 years, OS was 73.4% (95% CI: 66.0-81.1) and 90.5% (95% CI: 87.3-92.9), respectively (p < 0.001). Additionally, permanent stoma-free survival (PSFS) improved significantly over time, from 56.5% in Group 1 to 85.8% in Group 2 (p < 0.001).
The integration of robotic surgery, high-resolution MRI, and the W&W strategy has significantly improved oncological outcomes and sphincter preservation rates in patients with LADRC over the past two decades.
本研究旨在评估手术技术的进步和不断演变的新辅助治疗（NAT）方案如何影响局部晚期低位直肠癌（LADRC）患者的临床、病理和长期肿瘤学结局。特别强调了在23年期间，一位高年资结直肠外科医生不断变化的实践是如何反映这些进展的。
本回顾性队列研究纳入了2001年至2024年间接受NAT的561例LADRC患者。根据2013年进行分层，该年份标志着机构开始采用机器人手术、高分辨率3特斯拉MRI以及正式实施观察等待（W&W）策略：第一组（2001 - 2012年）和第二组（2013 - 2024年）。
第一组的中位随访时间（191±2.29个月）显著长于第二组（71±2.81个月）。第一组11.6%的患者发生局部复发（LR），第二组为6.9%（p = 0.107），远处转移（DM）分别为15.5%和10.6%（p = 0.178）（图2）。第一组5年无病生存率（DFS）为67.4%（95%CI：58.6 - 74.8），第二组为80.1%（95%CI：75.6 - 83.8）（p = 0.003）。10年时，第一组和第二组的DFS分别为65.2%（95%CI：58.6 - 74.8）和79.4%（95%CI：74.7 - 83.3）（p = 0.006）。同样，第一组5年总生存率（OS）为78.0%（95%CI：67.6 - 82.4），第二组为91.7%（95%CI：87.9 - 93.3）（p < 0.001）。10年时，OS分别为73.4%（95%CI：66.0 - 81.1）和90.5%（95%CI：87.3 - 92.9）（p < 0.001）。此外，无永久性造口生存率（PSFS）随时间显著提高，从第一组的56.5%提高到第二组的85.8%（p < 0.001）。
在过去二十年中，机器人手术、高分辨率MRI和W&W策略的整合显著改善了LADRC患者的肿瘤学结局和括约肌保留率。
