目的:直肠癌治疗中使用的外科手术方式可能会影响癌症复发。这项研究的目的是确定手术类型是否会影响直肠癌手术的肿瘤学结果。
方法:我们从瑞典结直肠癌注册中心收集了2013年至2017年接受R0/R1手术的TNMI-III期直肠癌患者的数据。哈特曼手术(HP)后的结果,比较前切除术(AR)和腹会阴切除术(APR),并进行多变量Cox回归分析.研究的主要结果是局部复发率。次要结果是远处转移,无病生存率和5年总生存率以及局部复发的危险因素。
结果:本研究共纳入4741例患者:614例接受HP,3075例接受AR,1052例接受APR。多变量Cox回归显示局部复发无差异,远处转移或无病生存。AR后总生存率更高(OR0.62,CI0.54-0.72)。局部复发的危险因素为术中肠穿孔(OR2.41,CI1.33-4.40),pT4肿瘤(OR1.93,CI1.11-3.4)和环状切缘阳性(OR5.62,CI3.28-9.61)。
结论:这项全国性研究表明,手术类型不影响局部复发率或远处转移。在不适合进行修复手术的患者中,HP是一种可行的替代方案,其肿瘤结局与APR相似。
OBJECTIVE: The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this
study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery.
METHODS: We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I-III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann\'s procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the
study was the local recurrence rate. The secondary outcomes were distant metastasis, disease-free survival and overall survival at 5 years as well as risk factors for local recurrence.
RESULTS: A total of 4741 patients were included in the
study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease-free survival. Overall survival was higher following AR (OR 0.62, CI 0.54-0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33-4.40), a pT4 tumour (OR 1.93, CI 1.11-3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28-9.61).
CONCLUSIONS: This nationwide
study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR.