不同新辅助治疗方案联合根治性手术治疗直肠癌的效果

Effect of Different Neoadjuvant Treatment Schemes Combined with Radical Surgery on Rectal Cancer

目的分析局部进展期中低位直肠癌实施长程同步放化疗与短程放疗联合根治性手术的疗效。方法回顾性分析2015年1月~2017年6月第九六七医院及北部战区总医院收治的76例局部进展期中低位直肠癌患者,按新辅助治疗方案不同将其分为长程治疗组(35例)和短程治疗组(41例),所有患者按指南要求在规定时间内接受根治性手术,比较两组肿瘤病理降期及病理完全缓解情况、手术相关指标、术后并发症及生存清理。结果长程治疗组T分期降期率、pCR率高于短程治疗组(48.57%vs24.39%)、(11.43%vs 0),差异有统计学意义(P<0.05);两组淋巴结转阴率比较,差异无统计学意义(P>0.05)。两组手术方式、具体术式、保肛情况、手术时间、术中出血量、术后排气时间及术后住院时间比较,差异均无统计学意义(P>0.05)。长程治疗组吻合口出血、吻合口瘘、肠梗阻、切口感染、肺部感染发生率低于短程治疗组,但差异无统计学意义(P>0.05)。长程治疗组1年、2年、3年总生存率分别为87.90%、71.90%、65.60%;短程治疗组1年、2年、3年总生存率分别为77.50%、59.50%、59.50%,曲线分析显示,两组肿瘤患者生存曲线分布比较,差异无统计学意义(P>0.05)。结论局部进展期中低位直肠癌行长程同步放化疗与短程放疗相比,主要的优势表现在T分期降期、病理完全缓解,且不会增加手术难度和术后并发症发生率。

Objective To analyze the curative effect of long-term concurrent radiotherapy and short-term radiotherapy combined with radical surgery for locally advanced mid-low rectal cancer.Methods A retrospective analysis of 76 patients with locally advanced middle and low rectal cancer admitted to No.967 Hospital and the North Theater General Hospital from January 2015 to June 2017.According to different neoadjuvant treatment plans,they were divided into long-term treatment group(35 cases)and short-term treatment group(41 cases).All patients received radical surgery within the specified time according to the guidelines.The two groups were compared with tumor pathological degradation and pathological completion.Relief,surgery-related indicators,postoperative complications and survival clearance.Results The T staging rate and pCR rate in the long-term treatment group were higher than those in the short-term treatment group(48.57%vs 24.39%)and(11.43%vs 0),the difference was statistically significant(P<0.05);There was no statistically significant difference in the rate of negative conversion of lymph nodes between the two groups(P>0.05).There was no statistically significant difference between the two groups of surgical methods,specific surgical procedures,anus preservation,surgical time,intraoperative blood loss,postoperative exhaust time and postoperative hospital stay(P>0.05).The incidence of anastomotic bleeding,anastomotic leakage,intestinal obstruction,incision infection,and lung infection in the long-term treatment group was lower than that in the short-term treatment group,but the difference was not statistically significant(P>0.05).The 1-year,2-year,and 3-year overall survival rates in the long-term treatment group were 87.90%,71.90%,and 65.60%,respectively;the 1-year,2-year,and 3-year overall survival rates in the short-term treatment group were 77.50%,59.50%,and 59.50%,respectively.Curve analysis showed that there was no statistically significant difference in the survival curve distribution between the two groups of tumor patients(P>0.05).Conclusion Compared with short-course radiotherapy for locally advanced middle and low rectal cancer,the main advantages of long-term concurrent radiotherapy and chemotherapy are that the T stage is downgraded,the pathology is completely relieved,and it does not increase the difficulty of surgery and the incidence of postoperative complications.