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Transanal Endoscopic Operation (TEO) in Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy: Is It Safe?

經肛門內視鏡手術運用於侵犯性直腸癌新輔助化放療後

摘要


Purpose. Transanal endoscopic resection has been proposed as an alternative to radical surgery for selected patients but there is still debate with regard to local recurrence and outcomes after neoadjuvant therapy. The aim of this study was to evaluate the oncologic outcome of transanal endoscopic resection for local excision of rectal cancer, and compare patients who had neoadjuvant chemoradiotherapy to those who did not. Methods. Retrospective analysis of p hod was used to estimate overall survival and disease-free survival. Univariate analysis was included in a stepwise multivariate logistic regression analysis to evaluate the risk factors associated with recurrence. Results. Of 67 patients undergoing transanal endoscopic resection, 28 patients had neoadjuvant chemoradiotherapy and 39 patients did not. Fragmented specimens (28.6% vs. 10.3%, p = 0.05) and suture dehiscence (17.9% vs. 2.6%, p = 0.031) were higher in neoadjuvant chemoradiotherapy group vs. no chemoradiotherapy group. After a mean follow-up of 41.5 months, 11 out of 67 patients (16.4%) sustained a local recurrence but no statistically significant difference was found between the two groups (21.4% vs. 12.8%, p = 0.35). Pathology T stage (p < 0.01), suture dehiscence (p = 0.01) and margin positivity (p = 0.01) were independent predictors of tumor recurrence. Conclusion. Transanal endoscopic resection in advanced rectal cancer following neoadjuvant chemotherapy was associated with high suture dehiscence and specimen fragmentation rates and high local recurrence rate after a mean follow up of 41 months. These results imply that transanal endoscopic resection should be reserved to highly selected patients.

並列摘要


目的:經肛門內鏡切除術已被作為特定患者根治性手術的替代方案,但仍然存在較高復發率的爭論。本研究的目的是評估經肛門內鏡切除術治療局部切除直腸癌,並比較接受新輔助放化療的患者與未接受新輔助放化療的患者。方法:病人收集於2012年至2016年區間。Kaplan-Meier method運算存活率和復發率。使用單因素分析包括在逐步多變量邏輯回歸分析中,以評估與復發相關的風險因素。結果:67例接受經肛門內鏡切除術的患者中,28例接受新輔助放化療,39例未接受新輔助放化療。新輔助放化療組與未放化療組相比,碎片標本(28.6%對比10.3%,p=0.05)和縫合開裂(17.9%對2.6%,p=0.031)更高。平均術後追蹤為41.5個月,67例患者中有11例(16.4%)出現局部復發,但兩組之間無統計學差異(21.4%對12.8%,p=0.35)。病理學T分期(p<0.01),縫線裂開(p=0.01)和邊緣陽性(p=0.01)是腫瘤復發的獨立預測因子。結論:新輔助化放療後經肛門內鏡下切除術與高位縫合開裂和標本碎裂率有關,平均術後追蹤41個月後局部復發率較高。這些結果意味著經肛門內視鏡切除術應保留給高度選擇的患者。

參考文獻


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