术前新辅助治疗与术中灌注化疗对中低位直肠癌预后的影响

Influence of Preoperative Neoadjuvant Therapy and Intraoperative Perfusing Chemotherapy in Patients with Mid-low Rectal Cancer

目的探讨新辅助治疗(术前采取的化疗和放疗措施)与术中灌注化疗对Ⅱ、Ⅲ期中低位直肠癌预后的影响。方法将我院收治的Ⅱ、Ⅲ期中低位直肠癌96例随机分为综合治疗组和传统治疗组两组,每组各48例。综合治疗组在传统手术治疗基础上术前予新辅助治疗,术中予灌注化疗;传统治疗组仅采用传统手术治疗。比较两组术后早期并发症发生率、局部复发率、远处转移率和5年生存率。结果 96例中3例因发生低位肠梗阻急诊手术治疗或行姑息性手术被排除(综合治疗组1例,传统治疗组2例),综合治疗组和传统治疗组术后早期并发症发生率分别为17.0%和13.0%,其中吻合口瘘发生率分别为6.4%和4.3%,两组比较差异均无统计学意义(P>0.05)。综合治疗组与传统治疗组术后局部复发率分别为6.4%和21.7%,差异有统计学意义(P<0.05);远处转移率分别为21.3%和32.6%,差异无统计学意义(P>0.05);5年生存率分别为72.3%和54.3%,差异有统计学意义(P<0.05)。结论术前新辅助治疗与术中灌注化疗可明显降低Ⅱ、Ⅲ期中低位直肠癌术后局部复发率,提高5年生存率,且安全可行。

Objective To explore influence of neoadjuvant therapy （a chemotherapy and radiotherapy measure before oper- ations） and intraoperative perfusing chemotherapy on prognosis in patients with stage Ⅱ/Ⅲ mid-low rectal cancer. Methods A total of 96 patients with stage Ⅱ/Ⅲ mid-low rectal cancer were randomly divided into two groups： combined therapy group （n = 48） with preoperative radiotherapy and intraoperative perfusing chemotherapy, and traditional group （n = 48） with traditional surgery. The in- cidence rates of postoperative complication, local recurrence rates, metastasis rates and five year survival rates of the two groups were compared. Results 3 out of the 96 patients were removed from the study for emergency operation for low-set intestinal ob- struction and palliative operation （ 1 of combined therapy group, 2 of traditional group）. The incidence rates of postoperative compli- cation were 17.0% in combined therapy group and 13.0% in traditional group, and the incidence rates of anastomosis fistula were 6.4% in combined therapy group and 4.3% in traditional group, and the differences of the two groups were not statistically signifi- cant （P 〉0. 05）. The local recurrence rates were 6.4% of combined therapy group and 21.7% of traditional group, and the differ- ences were statistically significant （P 〈 0.05 ）; metastasis rates were 21.3% in combined therapy group and 32. 6% in traditional group （P 〉0.05）; the five year survival rates were 72.3% in combined therapy group and 54.3% in traditional group, and the differences were statistically significant（P 〈 0.05 ）. Conclusion The neoadjuvant therapy combined with intraoperative perfusing chemotherapy can significantly reduce local recurrence rate and improve five year survival rate. It is safe and feasible for the patients with locally advanced mid-low rectal cancer.