Long-term outcomes of neoadjuvant therapy combined with intersphincteric resection for low/ultra-low rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TU Shengjin ^1,2 , ZHANG Wendi ^1,3 , LIU Jianbo ¹ , YIN Jin ^1,4 ,  WANG Xiaodong ¹ , LI Li ⁵ , YANG Lie ^1,6

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, Fourth People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;
3. West China Clinical Medical College of Sichuan University, Chengdu 610041, P. R. China;
4. Institute of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
6. Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Xiaodong, Email: wangxiaodong@wchscu.cn

Keywords：

rectal cancer; neoadjuvant therapy; intersphincteric resection; long-term outcome; complication; anal preservation

DOI：

10.7507/1007-9424.202404058

Video：

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Objective Based on the latest version of the Database from Colorectal Cancer(DACCA), this study analyzed the long-term effect of neoadjuvant therapy combined with intersphincteric resection (ISR) in patients with rectal cancer. Methods According to the established screening criteria, clinical data of 944 patients with rectal cancer admitted from January 2009 to December 2020 were collected from the DACCA updated on March 21, 2022, to explore the influencing factors for overall survival (OS) and disease specific survival (DSS) of rectal cancer treated with neoadjuvant therapy combined with ISR, by Cox proportional hazard regression model. Results ① The 3-year OS and DSS survival rates of neoadjuvant therapy combined with ISR for rectal cancer were 89.2% and 90.4%, respectively, and the 5-year OS and DSS survival rates were 83.9% and 85.4%, respectively. ② For different ISR surgical methods and neoadjuvant therapy plans, there were no significant differences in OS and DSS (P>0.05), but there were significant differences in OS and DSS among different ypTNM stage groups (P<0.001), patients with ypTNM 0–Ⅱ had better OS and DSS. ③ BMI, ypTNM stage and R0 resection were influencing factors for OS and DSS (P<0.05). ④ The overall incidence of postoperative complications was low, including 6.4% (60/944) within 30 days, 7.5% (71/944) within half a year and 3.3% (31/944) over half a year after operation. Conclusions In the comprehensive treatment of patients with low/ultra-low rectal cancer, neoadjuvant therapy combined with ISR can achieve relatively stable and good long-term oncological efficacy, and the incidence of short-term postoperative complications is not high, which is one of the options.

Citation： TU Shengjin, ZHANG Wendi, LIU Jianbo, YIN Jin, WANG Xiaodong, LI Li, YANG Lie. Long-term outcomes of neoadjuvant therapy combined with intersphincteric resection for low/ultra-low rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(5): 538-546. doi: 10.7507/1007-9424.202404058 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	王昕, 黃平. 低位直腸癌經括約肌間切除術的臨床研究與應用現狀. 結直腸肛門外科, 2020, 26(2): 238-242.
3.	尹周一, 王夢圓, 游偉程, 等. 2022美國癌癥統計報告解讀及中美癌癥流行情況對比. 腫瘤綜合治療電子雜志, 2022, 8(2):54-63.
4.	李干斌, 韓加剛, 王振軍, 等. 新輔助放化療治療局部進展期直腸癌療效分析. 中國實用外科雜志, 2021, 41(2): 184-189, 193.
5.	Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet, 2009, 373(9666): 811-820.
6.	姚宏偉, 張忠濤. 低位直腸癌臨床研究中值得關注的問題. 中國實用外科雜志, 2019, 39(7): 655-658.
7.	黃勝輝, 池畔, 林惠銘, 等. 腹腔鏡與開放經腹括約肌間切除術治療低位直腸癌的近期療效比較. 中華胃腸外科雜志, 2016, 19(8): 923-927.
8.	Xv Y, Fan J, Ding Y, et al. Latest advances in intersphincteric resection for low rectal cancer. Gastroenterol Res Pract, 2020, 2020: 8928109.
9.	劉素紅, 楊小景, 沈華杰. 腹腔鏡經括約肌間切除術在低位直腸癌患者中的應用效果. 癌癥進展, 2023, 21(3): 320-323.
10.	沈曉明, 劉如錢, 鮑傳慶. 腹腔鏡下全直腸系膜切除術聯合經肛管括約肌間切除術在超低位直腸癌保肛手術中的應用效果分析. 實用臨床醫藥雜志, 2017, 21(17): 131-132.
11.	汪曉東, 劉健博, 李立. 數據庫建設第六部分: 結直腸癌分期的標簽與結構化. 中國普外基礎與臨床雜志, 2020, 27(7): 873-879.
12.	李立. 結直腸癌外科應用技術的規范與創新(十五). 中國普外基礎與臨床雜志, 2008, 15(3): 215-217.
13.	劉雨晴, 毛笑笑, 冉昕昕, 等. 局部進展期直腸癌新輔助治療研究進展. 中國普外基礎與臨床雜志, 2023, 30(7): 882-888.
14.	秦啟元, 馬騰輝, 蔡建, 等. 經括約肌間切除術治療新輔助放化療后低位直腸癌的近遠期并發癥研究. 中華外科雜志, 2018, 56(12): 892-899.
15.	Bruheim K, Guren MG, Skovlund E, et al. Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys, 2010, 76(4): 1005-1011.
16.	Heriot AG, Tekkis PP, Fazio VW, et al. Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model. Ann Surg, 2005, 242(4): 502-510.
17.	吳登峰, 劉源, 田志強, 等. 機器人與腹腔鏡輔助直腸癌根治術的手術療效與預后對比. 中國腫瘤外科雜志, 2024, 16(1): 47-53.
18.	李干斌, 韓加剛, 王振軍, 等. 新輔助放化療治療局部進展期直腸癌的遠期療效及預后因素分析. 臨床外科雜志, 2021, 29(5): 422-427.
19.	韓元圣, 丁麗華. 腹腔鏡低位直腸癌部分、次全和完全經括約肌間切除術式的腫瘤學結果及肛門功能比較. 中國醫學創新, 2018, 15(35): 57-61.
20.	趙亞茹, 喬文波. 直腸癌新輔助放療研究進展. 現代腫瘤醫學, 2022, 30(19): 3614-3617.
21.	孫祺, 劉暢, 葉健喬, 等. 局部進展期中低位直腸癌單純新輔助化療與新輔助放化療的療效比較. 西安交通大學學報(醫學版), 2024, 45(2): 278-283.
22.	邵麗華, 陳剛. 極限保肛之低位直腸癌經括約肌間切除術(ISR). 中國腫瘤外科雜志, 2021, 13(2): 105-108.
23.	Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol, 2014 Suppl 3: S422-S428.
24.	Sakr A, Yang SY, Kang JH, et al. Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: comparative cross sectional study. J Surg Oncol, 2020, 121(2): 365-374.
25.	劉軍廣, 陳賀凱, 汪欣, 等. 腹腔鏡低位直腸癌經括約肌間切除術后吻合口漏的影響因素分析及預測模型構建. 中華外科雜志, 2021, 59(5): 332-337.
26.	伊建奎, 張立峰, 譚黃業, 等. 超低位直腸癌病人經括約肌間切除術后吻合口漏的危險因素分析. 腹部外科, 2023, 36(6): 463-467.
27.	齊恒鐸, 劉洋, 張珍瑜, 等. 低位直腸癌經括約肌間切除術后早期并發癥的危險因素分析及預測模型的構建. 中華普通外科雜志, 2022, 37(10): 743-748.
28.	應俊, 孫亞煌, 王安琪, 等. 腹腔鏡極低位直腸癌經括約肌間切除術后吻合口漏的影響因素及列線圖預測模型構建. 中華消化外科雜志, 2023, 22(4): 526-531.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 王昕, 黃平. 低位直腸癌經括約肌間切除術的臨床研究與應用現狀. 結直腸肛門外科, 2020, 26(2): 238-242.
3. 尹周一, 王夢圓, 游偉程, 等. 2022美國癌癥統計報告解讀及中美癌癥流行情況對比. 腫瘤綜合治療電子雜志, 2022, 8(2):54-63.
4. 李干斌, 韓加剛, 王振軍, 等. 新輔助放化療治療局部進展期直腸癌療效分析. 中國實用外科雜志, 2021, 41(2): 184-189, 193.
5. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet, 2009, 373(9666): 811-820.
6. 姚宏偉, 張忠濤. 低位直腸癌臨床研究中值得關注的問題. 中國實用外科雜志, 2019, 39(7): 655-658.
7. 黃勝輝, 池畔, 林惠銘, 等. 腹腔鏡與開放經腹括約肌間切除術治療低位直腸癌的近期療效比較. 中華胃腸外科雜志, 2016, 19(8): 923-927.
8. Xv Y, Fan J, Ding Y, et al. Latest advances in intersphincteric resection for low rectal cancer. Gastroenterol Res Pract, 2020, 2020: 8928109.
9. 劉素紅, 楊小景, 沈華杰. 腹腔鏡經括約肌間切除術在低位直腸癌患者中的應用效果. 癌癥進展, 2023, 21(3): 320-323.
10. 沈曉明, 劉如錢, 鮑傳慶. 腹腔鏡下全直腸系膜切除術聯合經肛管括約肌間切除術在超低位直腸癌保肛手術中的應用效果分析. 實用臨床醫藥雜志, 2017, 21(17): 131-132.
11. 汪曉東, 劉健博, 李立. 數據庫建設第六部分: 結直腸癌分期的標簽與結構化. 中國普外基礎與臨床雜志, 2020, 27(7): 873-879.
12. 李立. 結直腸癌外科應用技術的規范與創新(十五). 中國普外基礎與臨床雜志, 2008, 15(3): 215-217.
13. 劉雨晴, 毛笑笑, 冉昕昕, 等. 局部進展期直腸癌新輔助治療研究進展. 中國普外基礎與臨床雜志, 2023, 30(7): 882-888.
14. 秦啟元, 馬騰輝, 蔡建, 等. 經括約肌間切除術治療新輔助放化療后低位直腸癌的近遠期并發癥研究. 中華外科雜志, 2018, 56(12): 892-899.
15. Bruheim K, Guren MG, Skovlund E, et al. Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys, 2010, 76(4): 1005-1011.
16. Heriot AG, Tekkis PP, Fazio VW, et al. Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model. Ann Surg, 2005, 242(4): 502-510.
17. 吳登峰, 劉源, 田志強, 等. 機器人與腹腔鏡輔助直腸癌根治術的手術療效與預后對比. 中國腫瘤外科雜志, 2024, 16(1): 47-53.
18. 李干斌, 韓加剛, 王振軍, 等. 新輔助放化療治療局部進展期直腸癌的遠期療效及預后因素分析. 臨床外科雜志, 2021, 29(5): 422-427.
19. 韓元圣, 丁麗華. 腹腔鏡低位直腸癌部分、次全和完全經括約肌間切除術式的腫瘤學結果及肛門功能比較. 中國醫學創新, 2018, 15(35): 57-61.
20. 趙亞茹, 喬文波. 直腸癌新輔助放療研究進展. 現代腫瘤醫學, 2022, 30(19): 3614-3617.
21. 孫祺, 劉暢, 葉健喬, 等. 局部進展期中低位直腸癌單純新輔助化療與新輔助放化療的療效比較. 西安交通大學學報(醫學版), 2024, 45(2): 278-283.
22. 邵麗華, 陳剛. 極限保肛之低位直腸癌經括約肌間切除術(ISR). 中國腫瘤外科雜志, 2021, 13(2): 105-108.
23. Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol, 2014 Suppl 3: S422-S428.
24. Sakr A, Yang SY, Kang JH, et al. Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: comparative cross sectional study. J Surg Oncol, 2020, 121(2): 365-374.
25. 劉軍廣, 陳賀凱, 汪欣, 等. 腹腔鏡低位直腸癌經括約肌間切除術后吻合口漏的影響因素分析及預測模型構建. 中華外科雜志, 2021, 59(5): 332-337.
26. 伊建奎, 張立峰, 譚黃業, 等. 超低位直腸癌病人經括約肌間切除術后吻合口漏的危險因素分析. 腹部外科, 2023, 36(6): 463-467.
27. 齊恒鐸, 劉洋, 張珍瑜, 等. 低位直腸癌經括約肌間切除術后早期并發癥的危險因素分析及預測模型的構建. 中華普通外科雜志, 2022, 37(10): 743-748.
28. 應俊, 孫亞煌, 王安琪, 等. 腹腔鏡極低位直腸癌經括約肌間切除術后吻合口漏的影響因素及列線圖預測模型構建. 中華消化外科雜志, 2023, 22(4): 526-531.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Long-term outcomes of neoadjuvant therapy combined with intersphincteric resection for low/ultra-low rectal cancer

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