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中低位直肠癌新辅助放化疗后行经肛门局部切除19例疗效分析

Retrospective analysis of 19 cases with middle-to-low rectal cancer who underwent local excision following neoadjuvant chemoradiation
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摘要 目的探讨中低位直肠癌新辅助放化疗后行经肛门局部切除的有效性和安全性。方法回顾性分析2011年3月至2016年6月北京大学肿瘤医院胃肠肿瘤中心诊治的行新辅助放化疗并接受经肛门局部切除的19例中低位直肠癌病人的临床资料。主要的研究终点为:无病生存(disease free survival)、术后短期(1个月)并发症;次要研究终点为:术后1年的生活质量和肛门功能。结果肿瘤直径为1.0(0.3~3.0)cm。8例(42.1%)肿瘤位于前壁;6例(31.6%)位于后壁;3例(15.8%)位于左侧壁;2例(10.5%)位于右侧壁;肿瘤距肛缘中位距离为4.0(1.5~12.0)cm;术后病理学检查示;ypT0 12例(63.2%);ypT1 3例(15.8%);ypT2 4例(21.1%)。放化疗结束距手术的时间间隔为4.3(2.0~36.0)个月。局部切除手术时间为50(20~137)min;术中出血量为10(0~50)mL;术后住院时间为4(1~5)d。随访30(2~62)个月;1例局部复发;3例出现远处转移(1例腹盆腔和2例肺转移);肿瘤复发率为21.1%(4/19)。局部切除病例肛门功能评分术前和术后差异无统计学意义(P>0.05);而TME病例肛门功能评分术前和术后差异有统计学意义(P<0.05)。局部切除病例术后生活质量(EORTC QLQ-C30)和肛门功能(Wexner)评分低于同期TME手术组(P<0.01)。结论中低位直肠癌新辅助放化疗后;ycT0~2N0病例行经肛门局部切除是一种安全可行的治疗选择;可获得较好的肛门功能保留和生活质量。 Objective To investigate the prognosis and quality of life of patients who underwent transanal local excision (LE) following neoadjuvant chemoradiation for mid-low rectal cancer. Methods Patients undergo neoadjuvant chemoradiaiton and transanal local excision from March 2011 to June 2016 in Gastrointestinal cancer center;Peking University Cancer Hospital were enrolled in this study. Data of 19 cases were retrospectively collected and analyzed. The primary end points were disease free survival;short-term(1 month) postoperative complications;and secondary endpoints were quality of life and anal function one year after the surgery. Results Median tumor diameter was 1.0(0.3-3.0)cm. 8 (42.1%) cases located in the anterior wall;6 cases (31.6%) in the posterior wall;3 cases (15.8%) in the left wall;and 2 cases (10.5%) in the right wall. The median distance of the tumor from the anal verge was 4.0(1.5-12.0)cm. Postoperative pathology demonstrated that 12 cases (63.2%) ypT0;3 cases (15.8%) ypT1;4 cases (21.1%) ypT2;the median time interval between chemoradiotherapy and LE was 4.3(2.0-36.0)months;The median time of operation was 50(20-137)min;with median blood loss 10(0-50)ml and hospital stay 4(1-5)d. The recurrence rate was 21.1%(1 local recurrence;2 lung metastasis;1pelvic metastasis) with a follow up of 30(2-62) months. TME group had worse quality of life and anal function following TME surgery (P<0.01) while LE group not. LE group has better quality of life(EORTC-C30) and anal function (Wexner) than TME group (P<0.01). Conclusion For mid-low rectal cancer with good response (ycT0-2N0) following neoadjuvant chemoradiation;local excision might be a safe and feasible treatment option with acceptable anal function anal function.
作者 于洋 陈楠 王林 陈鹏举 彭亦凡 姚云峰 詹天成 赵军 武爱文 YU Yang;CHEN Nan;WANG Lin(Key Laboratory of Carcinogenesis and Tranlational Research (Ministry of Education),Unit,Gastrointestinal cancer center,Peking University Cancer Hospital & Institute,Beijing 100142,China)
出处 《中国实用外科杂志》 CSCD 北大核心 2019年第7期708-711,共4页 Chinese Journal of Practical Surgery
基金 国家自然科学基金(No.81773214) 首都特色临床研究(No.Z15110004015105) 北京市卫生系统215高层次人才项目(No.2016) 北京大学肿瘤医院院内基金(No.2017-自主-13).
关键词 直肠癌 新辅助放化疗 局部切除 生活质量 肛门功能 rectal cancer neoadjuvant chemoradiation local excision quality of life
作者简介 第一作者:于洋,于洋和陈楠对本文有同等贡献,均为第一作者;通信作者:武爱文,E-mail:wuaw@sina.com.
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