低位直肠癌强化或全程新辅助治疗后保直肠手术的临床疗效评价

Clinical efficacy evaluation of rectal preservation surgery after intensive or total neoadjuvant therapy for low rectal cancer

目的:探讨低位直肠癌强化或全程新辅助治疗(TNT)后保直肠手术的临床疗效。方法:2016年1-12月收治低位直肠癌患者50例,随机分为两组。B组应用TNT后开展保直肠手术,A组应用新辅助放化疗(nCRT)间歇期巩固化疗(强化nCRT)治疗后开展保直肠手术。比较两组手术有效性及并发症发生率。结果:A组放化疗后初次评估cCR 17例,Near-cCR 8例,局部切除24例,等待观察1例;二次评估cCR 19例,Near-cCR 6例。B组放化疗后初次评估cCR 11例,Near-cCR 22例,局部切除19例,等待观察6例;二次评估cCR 14例,Near-cCR 3例。A组初次评估疗效高于B组,B组二次评估疗效高于A组,但差异均无统计学意义(P>0.05)。B组并发症发生率略高于A组,但差异无统计学意义(P>0.05)。结论:低位直肠癌强化或TNT后保直肠手术的临床疗效值得肯定,但两者之间的差异性不显著,因此临床实际应用中可以灵活选择。

Objective:To investigate the clinical efficacy of rectal preservation surgery after intensive or total neoadjuvant therapy(TNT)for low rectal cancer.Methods:From January to December 2016,50 cases of patients with low rectal cancer were enrolled,they were randomly divided into two groups.Group B received rectal preservation surgery after TNT.Group A received rectal preservation surgery after the intensive nCRT of nCRT.The effectiveness of surgery and the incidence of complications between the two groups were compared.Results:In the group A,17 patients were evaluated cCR for the first time,8 cases for Near-cCR,24 cases for local resection,and 1 case for waited for observation.9 cases for secondary evaluation and 6 cases for Near-cCR.In the group B,11 cases were evaluated cCR,22 cases were Near-cCR,19 cases were local resection,6 cases were waited for observation,14 cases were secondary evaluation and 3 cases were Near-cCR.The first evaluation effect of group A was higher than that of group B,the effect of the second evaluation in group B was higher than that in group A,but the difference was not statistically significant(P>0.05).The incidence of complications in group B was slightly higher than that in group A,but the difference was not statistically significant(P>0.05).Conclusion:The clinical efficacy of rectal preservation surgery after intensive or total neoadjuvant therapy(TNT)for low rectal cancer is worthy of affirmation,and the difference between them is not significant,so it can be selected flexibly in clinical practice.