新辅助放化疗对直肠/肛管癌患者行经内外括约肌间切除术后近远期疗效的影响

Influence of neoadjuvant chemoradiotherapy on short and long term effects of inter-sphincteric resection for rectal/anal cancer

目的 探讨新辅助放化疗对直肠/肛管癌患者行经内外括约肌间切除术（ISR）后近远期疗效的影响.方法 直肠/肛管癌患者115例,根据患者术前是否行长周期（8周）新辅助放化疗分组,术前行长周期（8周）新辅助放化疗的患者定义为A组,术前未行长周期（8周）新辅助放化疗的患者定义为B组.两组均行经内外括约肌间切除术（ISR）.结果 从术后并发症发生率来看,A组肛周感染率明显高于B组（7.5％vs 0％）（P＜0.05）.从患者术后肛门功能恢复情况来看,两组术后2、3年肛门功能均较术后1年明显改善（P＜0.05）.两组间比较,A组术后1、2、3年肛门功能均较B组差（P＜0.05）.从远期效果来看,两组局部复发率及生存率差异无统计学意义（P＞0.05）.结论 新辅助化疗联合ISR治疗超低位直肠/肛管癌较单纯ISR,没有延缓患者术后近期恢复,且能够获得相似的生存率及局部复发率,但是,新辅助化疗增加了ISR手术患者术后肛周感染发生率,同时,对患者术后肛门功能造成一定的影响,但仍在患者可接受范围之内.

Objective To explore the influence of neoadjuvant chemoradiotherapy on short and long term effects of inter-sphincteric resection （ISR） for patients with rectal/anal cancer.Methods A total of 115 identified patients with rectal/anal cancer who received ISR from January 2009 to October 2009 were retrospectively enrolled.Patients were divided into two groups based on whether they received the preoperative long-term（8 weeks）neoadjuvant chemoradiotherapy or not.Patients with chemoradiotherapy were defined as Group A,and the others were Group B.Results For postoperative complications,perianal infection rate in Group A was obviously higher than Group B（7.5％ vs 0％,P ＜ 0.05）.Compared with the first year after operation,anal function at the second and third year improved significantly in both groups （P ＜ 0.05）.Besides,anal function at the 1 st,2nd and 3rd year after operation in Group A was worse than Group B （P ＜ 0.05）.The differences of local recurrence rate and survival rate between the two groups were not significant（P ＞ 0.05）.Conclusion Neoadjuvant chemoradiotherapy combined with ISR has not postponed the short-term recovery and it could reach similar survival and local recurrence rates compares with patients who only received ISR.However,neoadjuvant chemoradiotherapy could increase the rate of postoperative perianal infection in rectal/anal cancer patients.Meanwhile,it brought about some impacts on anal function after operation,but they were within the patients＇ acceptable ranges.