- 期刊
Clinical Outcomes of Transanal Endoscopic Microsurgery after Neoadjuvant Concurrent Chemoradiotherapy among Patients with T3N0M0 Rectal Cancer
T3N0M0直腸癌患者新輔助同步放化療後經肛門顯微內鏡手術的臨床結果？
摘要
Purpose. Total mesorectal excision is a standard surgical treatment for rectal cancer. Transanal endoscopic microsurgery is an alternative treatment that typically involves fewer complications but has a higher recurrence rate. This study examined whether transanal endoscopic microsurgery after neoadjuvant concurrent chemoradiotherapy is suitable as an alternative treatment for patients with cT3N0M0 rectal cancer. Methods. We retrospectively enrolled patients with cT3N0M0 rectal cancer who underwent neoadjuvant concurrent chemoradiotherapy between January 2016 and December 2021 at Taipei Medical University Hospital. Patients were divided into two groups according to whether they underwent total mesorectal excision or transanal endoscopic microsurgery. The clinical outcomes in each group were compared. Results. Of the 29 included patients, 17 underwent total mesorectal excision and 12 underwent transanal endoscopic microsurgery. The transanal endoscopic microsurgical approach resulted in less blood loss and shorter operating and hospitalization times than total mesorectal excision (p < 0.05). The median follow-up period was 51.0 (27.0-64.0) months. Among patients who underwent transanal endoscopic microsurgery, one had local recurrence, and none had distant metastases. The 3-year disease-free survival rates of the groups were similar. No significant differences in local recurrence and distant metastasis were observed. Conclusions. Transanal endoscopic microsurgery after neoadjuvant concurrent chemoradiotherapy among select patients with cT3N0M0 rectal cancer is a safe and feasible procedure that preserves the rectum. The degree of complete remission may be a key factor in determining whether a patient can receive transanal endoscopic microsurgery.
並列摘要
目的：全直腸系膜切除術是直腸癌的標準治療方法，但可能會出現多種手術併發症。與全直腸系膜切除術不同，經肛門內視鏡顯微手術的副作用較低，但對局部晚期直腸癌的複發率較高。本研究的目的是驗證經肛門內視鏡顯微手術是否可以作為臨床分期cT3N0M0的直腸癌患者在新輔助同步放化療後的替代治療。方法：我們回顧性分析了2016年1月至2021年12月在台北醫學大學附設醫院臨床分期為cT3N0M0的直腸癌患者，所有患者接受新輔助同步放化療後，分為全直腸系膜切除術組和經肛門內視鏡顯微手術組兩組，對臨床療效進行隨訪和比較。結果：在納入的29例患者中，17例接受了全直腸系膜切除術，12例接受了經肛門內視鏡顯微手術。與全直腸系膜切除術相比，經肛門內視鏡顯微手術在統計學上顯著減少了失血量、手術時間和住院時間。在平均隨訪51.0（27.0-64.0）個月後，經肛門內視鏡顯微手術組有1例患者局部復發，無遠處轉移。兩組患者的三年無病存活率相似，局部復發和遠處轉移的概率無顯著差異。結論：我們的經驗表明對於臨床分期為cT3N0M0的直腸癌患者，經肛門內視鏡顯微手術加上新輔助同步放化療是一種安全有效的方法，病理性緩解程度可能是這類患者可以是否接受肛門內視鏡顯微手術的關鍵因素。