局部进展期低位直肠癌伴侧方淋巴短径<10 mm新辅助治疗后TME+LLND术的临床研究

Clinical study of TME+LLND after neoadjuvant therapy for locally advanced low rectal cancer with lateral lymphoid short diameter<10 mm

目的研究局部进展期低位直肠癌伴侧方淋巴结短径<10 mm新辅助长程同步放化疗后全直肠系膜切除术(TME)+侧方淋巴结清扫术(LLND)的应用价值。方法前瞻性选取2018年6月至2021年6月126例局部进展期低位直肠癌患者,按照随机数字表法分为两组,每组患者各63例。对照组患者行新辅助长程同步放化疗+TME,观察组在对照组的基础上行LLND。采用SPSS 24.0完成数据分析。围手术期指标等计量资料用(x±s)表示,组间采用独立样本t检验;术后并发症等计数资料采用χ^(2)检验;Kaplan-Meier法和Log-Rank检验分析两组患者预后情况。P<0.05为差异有统计学意义。结果观察组患者手术时间显著长于对照组,术中出血量、淋巴结清扫总数均多于对照组,差异有统计学意义(P<0.05);两组患者最大尿意尿量、膀胱残余尿量、国际勃起功能指数(IIEF)评分、术后并发症总发生率比较差异均无统计学意义(P>0.05);中位随访时间为31个月,观察组患者累积无病生存率显著高于对照组(74.6%vs.58.7%),差异有统计学意义(Log-Rankχ^(2)=4.628,P=0.036);两组患者累积总生存率为77.8%、63.5%,组间差异无统计学意义(Log-Rankχ^(2)=2.984,P=0.077)。结论相比单纯nCRT+TME治疗局部进展期低位直肠癌,在术中联合侧方淋巴结清扫虽增加了手术时间和术中出血,但可有效控制术后局部复发,且不增加术后并发症的发生率,具有积极的临床意义。

Objective To investigate the application value of neoadjuvant long-term simultaneous chemoradiotherapy total mesorectal resection(TME)+lateral lymph node dissection(LLND)for locally advanced low rectal cancer with lateral lymph node diameter<10 mm.Methods A total of 126 patients with locally advanced low rectal cancer from June 2018 to June 2021 were prospectively selected and divided into two groups according to random number table method,with 63 patients in each group.The control group received neoadjuvant long-course concurrent chemoradiotherapy+TME,and the observation group received LLND on the basis of the control group.SPSS 24.0 was used to complete the data analysis.Measurement data such as perioperative indicators were represented by(x±s),and independent sample t test was used between groups.The statistical data of postoperative complications were tested byχ^(2).Kaplan-Meier test and Log-Rank test were used to analyze the prognosis of the two groups.P<0.05 was considered statistically significant.Results The operative time of observation group was significantly longer than that of control group,and the amount of intraoperative blood loss and the total number of lymph node dissection were higher than those of control group,the difference was statistically significant(P<0.05).There were no significant differences in maximum urine volume,bladder residual urine volume,International erectile function index(IIEF)score and total incidence of postoperative complications between 2 groups(P>0.05).The median follow-up time was 31 months.The cumulative disease-free survival rate in observation group was significantly higher than that in control group(74.6%vs.58.7%),with statistical significance(Log-Rankχ^(2)=4.628,P=0.036).The cumulative overall survival rate of the two groups was 77.8%and 63.5%,and there was no significant difference between the two groups(Log-Rankχ^(2)=2.984,P=0.077).Conclusion Compared with nCRT+TME alone in the treatment of locally advanced low rectal cancer,although the intraoperative combination with lateral lymph node dissection increased the operative time and intraoperative bleeding,it could effectively control postoperative local recurrence without increasing the incidence of complications,which has positive clinical significance.