Chemo-radiotherapy Followed by Full-thickness Local Excision with Transanal Endoscopic Microsurgery for Rectal Cancer: Long-term Survival and Outcome Analysis

直腸癌經放射治療及化學治療後，行局部廣泛切除之長期存活率分析

王貫宇(Kuan-Yu Wang) ； 盧建璋(Chien-Chang Lu)

《中華民國大腸直腸外科醫學會雜誌》 29卷4期 (2018/12) Pp. 197-203

https://doi.org/10.6312/SCRSTW.201812_29(4).10714

摘要

Purpose. Compared with traditional radical surgery for rectal cancer, patients who underwent chemo-radiotherapy followed by transanal endoscopic microsurgery (TEM) have less risk of complications and neither a temporary nor a permanent enterostomy. This study aimed to analyze the long-term oncological prognosis and survival of selected patient with rectal cancer undergoing TEM after neoadjuvant chemo-radiotherapy. Methods. From September 2013 to March 2015, there were 18 patients with rectal cancer who received neoadjuvant chemo-radiotherapy followed by TEM. Data of survival rate, local recurrence rate, and tumor characteristics were collected and analyzed. Results. In 18 patients with rectal cancer undergoing TEM, there were only two patients who developed local recurrence/distant metastasis during regular follow-up after surgery. The 3-year survival rate was 100%, local recurrence rate was 5.6%, and disease-free survival rate was 88.9%. Four patients (22.2%) had complications at the surgical site (including infection, leakage, poor healing, and dehiscence), one of them had a temporary transverse colon colostomy because of severe ischio-rectal abscess. Conclusions. Although TEM is not a traditional radical surgery for rectal cancer, it has the advantage of preserving the anus in low and ultra-low rectal malignancies. Furthermore, the outcome is not inferior to that of traditional radical surgery.

關鍵字

Transanal endoscopic microsurgery ； Rectal cancer ； Chemo-radiotherapy

並列摘要

目的：與傳統根治性手術比較，直腸癌病患經放射治療及化學治療後，接受經肛門內視鏡顯微手術(TEM)有助於降低手術相關併發症發生之機會，並大幅降低暫時性或永久性腸造口之可能性。此篇研究將分析特定直腸癌病患經放射治療及化學治療後，接受TEM做全層局部廣泛切除手術後，長期的預後及存活率。方法：從2013年9月至2015年3月，共有18位直腸癌病患經放射治療及化學治療後，接受TEM做全層局部廣泛切除手術。病患的存或率、局部及遠端復發率及併發症發生率在文章中將做分析及討論。結果：18位病人中，有2位於術後發生局部復發或遠端轉移。三年存活率為100%，局部復發率5.6%，無疾病存活率88.9%。4位病患於手術部位有局部併發症（感染、滲漏、癒合不佳等），併發症發生率22.2%；其中1位因局部感染引發坐骨直腸膿瘍，而須做暫時性腸造口。結論：雖然肛門內視鏡顯微手術(TEM)並非傳統根治性手術，但對於中低位直腸惡性腫瘤，經放化療後如有顯著臨床反應，接受全層局部廣泛切除手術可降低併發症發生機率，且病患預後亦佳。

並列關鍵字

直腸癌 ； 放射治療 ； 局部切除

參考文獻

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