腹腔镜辅助低位Ⅰ期直肠癌切除的远端切缘长度对远期预后的影响

The impact of distal resection margin on the long-term oncological outcome of stage Ⅰ lower rectal cancer after laparoscopic-assisted radical surgery

目的:探究腹腔镜辅助Ⅰ期低位直肠癌根治性切除术中远端切缘长度对远期预后的影响。方法:回顾分析2011年1月至2013年12月收治的86例Ⅰ期低位直肠癌患者的临床资料,标本福尔马林固定后,根据病理科测量的远端切缘长度,分为A组(远端切缘<1 cm+吻合环)、B组(远端切缘≥1 cm+吻合环)与Miles组,对比分析3组5年无瘤生存率、5年总生存率。结果:Ⅰ期低位直肠癌,Miles组与B组相比,5年无瘤生存率(94.7%vs. 94.7%,P=0.794)、5年总生存率(97.1%vs.94.4%,P=0.446)差异无统计学意义;与B组相比,A组5年无瘤生存率(69.6%vs. 94.7%,P=0.020)、5年总生存率(80.6%vs. 94.4%,P=0.042)较差。结论:远端切缘长度是影响低位直肠癌远期预后的重要因素,低位直肠癌的保肛治疗中需保证远端切缘长度≥1 cm(标本固定后),外科医生术中离断肠管前应预留更长的距离。

Objective:To investigate the impact of distal resection margin(DRM)on the long-term oncological outcome of stageⅠlower rectal cancer after laparoscopic-assisted radical surgery.Methods:Clinical data of 86 patients who suffered from stageⅠlower rectal cancer from Jan.2011 to Dec.2013 were retrospectively analyzed.45 patients underwent laparoscopic-assisted abdominoperineal resection surgery,24 patients received laparoscopic-assisted ultra-low anterior resection with a DRM<(1 cm+anastomosis ring),21 patients received laparoscopic-assisted ultra-low anterior resection with a DRM≥(1 cm+anastomosis ring).The 5-year disease-free survival rate and 5-year overall survival rate were compared.Results:For stageⅠlower rectal cancer,the 5-year disease-free survival rate and 5-year overall survival rate of Miles group and DRM≥(1 cm+anastomosis ring)group were not significantly different(94.7%vs.94.7%,P=0.794;97.1%vs.94.4%,P=0.446,respectively).The 5-year disease-free survival rate and 5-year overall survival rate in DRM≥(1 cm+anastomosis ring)group was superior than that in DRM<(1 cm+anastomosis ring)group(94.7%vs.69.6%,P=0.020;94.4%vs.80.6%,P=0.042,respectively).Conclusions:The DRM is of great importance for the long-term prognosis of lower rectal cancer.To preserve the sphincter of patients who suffered from lower rectal cancer,the DRM greater than 1 cm must be ensured,and the pathological measurement should be taken as the standard,which means the surgeon should cut a longer distance from the tumor.