Oncologic Results of Transanal Local Excision for Clinically T_(0-2)-staged Distal Rectal Cancer

經肛門腫瘤切除治療T_(0-2)下段直腸癌結果與預後之探討

林俞廷(Yu-Ting Lin) ； 陳姿君(Tzu-Chun Chen) ； 洪基翔(Ji-Shiang Hung) ； 黃約翰(John Huang) ； 梁金銅(Jin-Tung Liang)

《中華民國大腸直腸外科醫學會雜誌》 33卷2期 (2022/06) Pp. 60-66

https://doi.org/10.6312/SCRSTW.202206_33(2).11027

摘要

Purpose. To investigate the oncologic outcomes of transanal local excision for patients with clinically T_(0-2)-staged distal rectal cancer. Methods. Between October 2009 and January 2021, we recruited 25 consecutive patients with T_(0-2)-staged rectal adenocarcinoma based on clinical staging undergoing transanal local excision. We excluded patients with a history of colorectal cancer, anal cancer, or Paget's disease, or those who received pre-operative concurrent chemoradiotherapy (CCRT).We analyzed the clinic-pathologic characteristics of the patients, including demographics, tumor size and stage, surgical complications, 30-day mortality rates, cancer recurrence rates, and overall survival. Results. A total of 18 patients were analyzed, excluding the 7 ineligible patients. The mean age at diagnosis was 66.7 ± 9.5 years. The distance of the tumor location was 3.2 ± 1.5 cm above anal verge. The tumor diameter was 2.87 ± 1.3 cm. No surgical complications were found. The mean duration of follow-up was 42.7 ± 27.3 months, during which time 2 (11.1%) patients developed local tumor recurrence. The one had local recurrence with lung metastases after 3-year follow-up, and received salvage CCRT with radical surgery for resection. The other patient had peri-rectal lymphadenopathy recurrence after 4-year follow-up. The estimated 5-year overall survival was 100%. There were no cancer-related deaths during the follow-up period. Conclusions. This study showed it is feasible to treat patients with clinically T_(0-2)-staged distal rectal cancer using transanal local excision, which was associated with favorable oncological outcomes. Future randomized control trials with a longer duration of follow-up are required in order to conclusively establish the role of local tumor excision for the management of patients with distal rectal cancer.

關鍵字

Rectal cancer ； Transanal tumor excision

並列摘要

目的：藉由本研究呈現經肛門局部腫瘤切除手術對T_(0-2)下段直腸癌之治療成果。方法：本研究回溯性蒐集於2009年10月至2021年1月間臨床診斷T_(0-2)下段直腸腺癌接受經肛門局部腫瘤切除手術的病患。其中先前有其他癌症病史、合併有肛門癌、術前做過同步化學放射治療等病患予以排除，我們蒐集病患之臨床資 訊、腫瘤分期、大小、術後併發症、復發率及五年存活率等並加以分析。結果：最後共計十八名病患被納入此篇研究，另外有七名病患被排除於此研究。十八名病患平均年齡為66.7歲（標準差9.5年），腫瘤距肛門口平均距離為2.87公分（標準差1.3公分），術後並沒有重大併發症，其中兩位病患在後續追蹤的五年內有復發情形，一人在追蹤第三年時出現局部復發及肺部轉移情形並接受同步化學放射治療及根除手術，另一人在追蹤第四年時出現直腸旁淋巴結復發並接受同步化學放射治療，推估五年存活率為100%，復發率為11.1%，在追蹤期間並無癌症相關死亡，平均追蹤時間為42.7個月（標準差27.3個月）。結論：本研究顯示經肛門局部腫瘤切除手術治療早期T_(0-2)下段直腸腺癌是可行且其預後與復發率是可接受的，希望藉由現行研究，未來能夠做隨機對照試驗並長期追蹤以了解經肛門局部腫瘤切除手術對治療早期直腸腺癌的角色。

並列關鍵字

直腸癌 ； 經肛門腫瘤切除

參考文獻

Nastro, P., Beral, D., Hartley, J., & Monson, J. R. Local excision of rectal cancer: review of literature. Digestive surgery. 2005;22(1-2): 6-15.

Garcia-Aguilar, J., Mellgren, A., Sirivongs, P., Buie, D., Madoff, R. D., & Rothenberger, D. A. Local excision of rectal cancer without adjuvant therapy: a word of caution. Annals of surgery. 2000;231(3):345.

Sengupta, S., Tjandra, J.J. Local excision of rectal cancer: what is the evidence?. Dis Colon Rectum. 2001;44(9):1345-1361

Hwang, Y., Yoon, Y.S., Bong, J.W., et al. Long-term Transanal Excision Outcomes in Patients With T1 Rectal Cancer: Comparative Analysis of Radical Resection. Ann Coloproctol. 2019;35(4):194-201.

You, Y.N., Baxter, N.N., Stewart, A., Nelson, H. Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg. 2007;245(5):726-733.