新辅助放化疗对局部进展期直肠癌保肛术后排便功能的影响

Effect of neoadjuvant radiochemotherapy on defecation function after sphincter preserving surgery for locally advanced rectal cancer

目的:探讨新辅助放化疗对局部进展期直肠癌保肛术后排便功能的影响。方法:回顾性分析2013年至2016年我院185例局部进展期直肠癌行直肠低位前切除术患者的临床和病理资料,采用低位前切除综合征(LARS)评分量表评估患者术后排便功能状况,通过单因素和多因素Logistic回归分析影响患者术后排便功能的危险因素。结果:所有患者均严格遵循直肠全系膜切除术(TME)原则行低位前切除术,其中113例行术前(新辅助)放化疗,50例行术后(辅助)放化疗,22例未行放化疗。术后12~48个月中,患者中LARS的发生率为64.9%,重度LARS的发生率为31.9%,重度LARS患者占全部LARS患者的49.2%。单因素分析发现,接受放化疗者术后重度LARS发生比例显著高于未接受放化疗者(P<0.001),肿瘤距肛缘距离<5cm者术后重度LARS发生比例显著高于≥5 cm者(P=0.001),开放手术者术后重度LARS发生比例显著高于腹腔镜手术者(P=0.038),然而放化疗的不同时机(新辅助、辅助)、新辅助放化疗的不同形式(长程放化疗、短程放疗)对术后重度LARS发生比例的影响,差异并无统计学意义(P>0.05)。多因素分析发现,只有放化疗(P=0.001)、肿瘤距肛缘距离<5 cm(P=0.003)是术后发生重度LARS的独立危险因素。结论:LARS是直肠癌保肛术后长期困扰患者的常见并发症,放化疗、肿瘤位置较低是导致术后LARS的独立危险因素。然而,新辅助放化疗与辅助放化疗,长程放化疗与短程放疗对术后LARS发生的影响基本相似。

Objective：To investigate the effect of neoadjuvant radiochemotherapy on defecation function in patients with locally advanced rectal cancer after sphincter preserving surgery.Methods：The clinical and pathological data of 185 patients with locally advanced rectal cancer undergoing low anterior resection from 2013 to 2016 in our hospital were retrospectively analyzed.The defecation function of all the patients were assessed using the low anterior resection syndrome （LARS） score.Univariate and multivariate analyses were used to determine the independent risk factors for LARS.Results：In this series,all patients underwent low anterior resection with the technique of total mesorectal excision （TME）.Preoperative neoadjuvant radiochemotherapy were performed in 113 cases ,postoperative adjuvant radiochemotherapy in 50 cases and 22 cases without radiochemotherapy.The incidence rate of LARS was 64.9% after a median time of 12～48 months since the primary surgery.Major LARS was observed in 31.9% of all patients and in 49.2% of LARS.Univariate analysis showed that the proportion of severe LARS in patients undergoing radiochemotherapy（P〈 0.001）,with a distance from the distal margin of tumor to anal verge 〈5 cm （P=0.001）,and laparotomy （P=0.038） were associated with major LARS.However,the different timing of radiochemotherapy （neoadjuvant or adjuvant）,and different forms of neoadjuvant radiochemotherapy （long-course radiochemotherapy or short-course radiotherapy） were not associated with major LARS（P〉 0.05）.Multivariate analysis showed that radiochemotherapy （P=0.001）,and a low tumor height （P=0.003） had a markedly increased risk of developing severe LARS.Conclusion：LARS is a long-standing common complication after low anterior resection in patients with rectal cancer patients.Radiochemotherapy and a low tumor height are the independent risk factors of LARS.However,whether neoadjuvant or adjuvant radiochemotherapy,long-course radiochemotherapy or short-course radiotherapy have similar effects on LARS.