低位直肠癌新辅助治疗达到almost-cCR(near-cCR)的缩小手术和根治术疗效的对照研究

A comparative study of the minimally invasive surgery and radical surgery in low rectal cancer with almost-cCR (near-cCR) after neoadjuvant therapy

目的:总结低位直肠癌行新辅助治疗原发肿瘤达到almost-cCR(almost-clinical complete response)后,比较缩小手术和根治术两种术式的优缺点。方法:回顾性分析2013年1月至2018年10月间,辽宁省肿瘤医院大肠科收治的局部晚期低位直肠癌经新辅助治疗原发肿瘤达到almost-cCR(near-cCR)的共35例患者的临床和病理资料。采用Kaplan-Meier法绘制生存曲线。结果:35例病人中,缩小手术组共纳入9例患者,根治术组共纳入26例患者。缩小手术组未出现术后并发症,根治术组3例患者出现术后并发症,发生率11.5%。缩小手术组1年和2年无复发生存率均为100%。根治术组1年和2年无复发生存率分别为96.1%和88.4%。缩小手术组中位DFS和OS均为32.1个月。根治术组中位DFS和OS分别为43.2个月和39.6个月。结论:对于低位直肠癌新辅助治疗达到almost-cCR(near-cCR)的病人,缩小手术组可以取得不亚于根治术组的临床疗效。并且减少手术创伤,改善近期疗效和远期预后。

Objective:To summarize the advantages and disadvantages of minimally invasive surgery and radical surgery when primary low rectal cancer have reached almost-cCR(almost-clinical complete response).Methods:We had retrospectively analyzed clinical and pathological data of 35 cases of locally advanced low rectal cancer reaching almost-cCR(near-cCR)in the Liaoning Cancer Hospital from January 2013 to October 2018.Survival curves were plotted using Kaplan-Meier method.Results:Among the 35 patients,minimally invasive surgery group included 9 patients and radical surgery group included 26 patients.No postoperative complications were found in the reduction surgery group,and postoperative complications were found in 3 patients of the radical surgery group,with an incidence of 11.5%.In the minimally invasive surgery group,both the 1-year and 2-year recurrence-free survival rate were 100%.The 1-year and 2-year recurrence-free survival rate of the radical group were 96.1%and 88.4%respectively.The median DFS and OS were 32.1 months and 32.1 months respectively in the minimally invasive surgery group and the median DFS and OS were 43.2 months and 39.6 months in the radical group.Conclusion:For lower rectal cancer with almost-cCR(near-cCR),minimally invasive surgery is similar with radical surgery in clinical efficacy.And minimally invasive surgery could reduce surgical trauma,improve short-term efficacy and long-term prognosis compared with radical surgery.