新辅助治疗对进展期直肠癌手术及术后的影响

Impact of Neoadjuvant Therapy on Local Advanced Rectal Cancer Surgery in the Perioperative and Postoperative Periods

目的:分析新辅助治疗对进展期直肠癌手术及术后的影响。方法:回顾性分析2010年1月至2010年12月中国医学科学院肿瘤医院腹部外科收治的进展期直肠癌患者,其中新辅助治疗后再手术组34例(A组),与同期直肠癌直接手术组146例(B组)进行对照,观察两组患者临床资料、手术情况、围手术期并发症、术后恢复情况及术后1年随访情况。结果:A、B两组肿瘤切除率为100%及89%,R0切除率为97.1%及82.9%,保肛率为73.5%及54.8%,围手术期并发症发生率为5.9%及4.8%。两组之间比较差异有统计学意义(均P<0.05)两组患者的手术时间、术后恢复时间、术后并发症发生率比较差异无统计学意义。随访1年A、B两组局部复发分别为0及16例,肝转移例数分别为1例及5例。结论:新辅助治疗可明显提高进展期直肠癌的肿瘤切除率、R0切除率及保肛率,并可降低局部复发率、对手术时间、术后恢复时间及围手术期并发症无影响。

Objectives： To investigate the impact of neoadjuvant therapy on local advanced rectal cancer surgery in the perioperative and postoperative periods. Methods： The medical records of 34 patients who underwent surgery after neoadjuvant therapy for local advanced rectal cancer （ group A ） and 146 patients who underwent surgery without neoadjuvant therapy at the same stage （ group B ） between January 2010 and December 2010 were retrospectively reviewed. Results： The tumor resection rates in groups A and B were 100 % and 89 %, the R0 resection rates were 97.1% and 82.9 %, the sphincter-saving rates were 73.5 % and 54.8 %, and the perioperative complication rates were 5.9 % and 4.8 %, respectively. The average operation time, postoperative recovery time, and perioperative complication rate did not have significant statistical differences. In the follow-up after 1 year, the local recurrence and liver metastases in groups A and B were 0 vs. 16 and 1 vs. 5, respectively. Conclusion： Neoadjuvant therapy for local advanced rectal cancer does not increase the average operation time, postoperative recovery time, and perioperative complications. This therapy can also significantly improve the tumor resection, RO resection, and sphincter-saving rates, as well as reduce the local recurrence rate.