不符合观察等待资格的远端直肠癌患者的结果：括约肌间切除术与腹会阴切除术的比较。
Outcomes of Distal Rectal Cancer Patients Who Did Not Qualify for Watch-and-Wait: Comparison of Intersphincteric Resection Versus Abdominoperineal Resection.
发表日期：2024 Oct 12
作者：
Yael Feferman, Floris S Verheij, Hannah Williams, Dana M Omer, Emmanouil P Pappou, Iris H Wei, Maria Widmar, Garrett M Nash, Philip B Paty, J Joshua Smith, Andrea Cercek, Rona Yaeger, Neil H Segal, Paul B Romesser, Christopher Crane, Leonard B Saltz, Martin R Weiser, Julio Garcia-Aguilar
来源：
ANNALS OF SURGICAL ONCOLOGY
摘要：
全直肠系膜切除术（TME）联合括约肌间切除术和手缝结肠肛门吻合术（ISR-CAA）已被证明对于术前放化疗的远端直肠癌患者具有肿瘤学安全性。针对新辅助治疗临床完全缓解的直肠癌患者引入观察等待 (WW) 策略，正在改变新辅助治疗后立即接受 TME 手术的患者的情况。尚未对不符合 WW 条件的局部晚期直肠癌患者进行 ISR-CAA 的结果进行调查。我们对接受新辅助治疗的远端直肠癌患者进行 ISR-CAA 和腹会阴切除术 (APR) 的结果进行了回顾性分析并且不符合 WW 资格，在具有既定 WW 计划的综合癌症中心进行治疗。主要结局是局部无复发生存期。67 名患者患有 ISR-CAA，79 名患者患有 APR。中位随访时间为 61.1 个月。两组在性别、肿瘤分期、分级和距肛缘距离方面相似，但 APR 组患者平均年龄较大。 94% 的 ISR-CAA 患者和 91% 的 APR 患者实现了 R0 切除。与 APR 组相比，ISR-CAA 组患者的 5 年局部无复发生存率较低（79% vs. 93%；p = 0.038）；然而，组间 5 年无病生存率没有显着差异（ISR-CAA 为 67%，APR 为 64%；p = 0.19）。对于未接受过 ISR-CAA 治疗的患者，ISR-CAA 后的局部复发率可能高于 APR 后的局部复发率。对需要 TME 手术的新辅助治疗的临床完全缓解。© 2024。外科肿瘤学会。
Total mesorectal excision (TME) with intersphincteric resection and handsewn coloanal anastomosis (ISR-CAA) has been shown to be oncologically safe in patients with distal rectal cancer treated with preoperative chemoradiation. The introduction of the watch-and-wait (WW) strategy for rectal cancer patients with a clinical complete response to neoadjuvant therapy is changing the profile of patients undergoing TME surgery immediately following neoadjuvant treatment. The outcomes of ISR-CAA for patients with locally advanced rectal cancers not qualifying for WW have not been investigated.We conducted a retrospective analysis comparing the outcomes of ISR-CAA and abdominoperineal resection (APR) in patients with distal rectal cancer treated with neoadjuvant therapy and not qualifying for WW, at a comprehensive cancer center with an established WW program. The primary outcome was local recurrence-free survival.Sixty-seven patients had ISR-CAA and 79 had APR. Median follow-up was 61.1 months. The two groups were similar in sex, tumor stage, grade, and distance from the anal verge, but patients in the APR group were older on average. An R0 resection was achieved in 94% of ISR-CAA patients and 91% of APR patients. Patients in the ISR-CAA group had a lower 5-year rate of local recurrence-free survival (79% vs. 93%; p = 0.038) compared with the APR group; however, 5-year disease-free survival did not differ significantly between groups (67% for ISR-CAA and 64% for APR; p = 0.19).The local recurrence rate after ISR-CAA may be higher than after APR for patients without a clinical complete response to neoadjuvant therapy requiring TME surgery.© 2024. Society of Surgical Oncology.