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, 黄平. 低位直肠癌经括约肌间切除术的临床研究与应用现状. 结直肠肛门外科, 2020, 26(2): 238-242.
3.	尹周一, 王梦圆, 游伟程, 等. 2022美国癌症统计报告解读及中美癌症流行情况对比. 肿瘤综合治疗电子杂志, 2022, 8(2):54-63.
4.	李干斌, 韩加刚, 王振军, 等. 新辅助放化疗治疗局部进展期直肠癌疗效分析. 中国实用外科杂志, 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.	姚宏伟, 张忠涛. 低位直肠癌临床研究中值得关注的问题. 中国实用外科杂志, 2019, 39(7): 655-658.
7.	黄胜辉, 池畔, 林惠铭, 等. 腹腔镜与开放经腹括约肌间切除术治疗低位直肠癌的近期疗效比较. 中华胃肠外科杂志, 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.	刘素红, 杨小景, 沈华杰. 腹腔镜经括约肌间切除术在低位直肠癌患者中的应用效果. 癌症进展, 2023, 21(3): 320-323.
10.	沈晓明, 刘如钱, 鲍传庆. 腹腔镜下全直肠系膜切除术联合经肛管括约肌间切除术在超低位直肠癌保肛手术中的应用效果分析. 实用临床医药杂志, 2017, 21(17): 131-132.
11.	汪晓东, 刘健博, 李立. 数据库建设第六部分: 结直肠癌分期的标签与结构化. 中国普外基础与临床杂志, 2020, 27(7): 873-879.
12.	李立. 结直肠癌外科应用技术的规范与创新(十五). 中国普外基础与临床杂志, 2008, 15(3): 215-217.
13.	刘雨晴, 毛笑笑, 冉昕昕, 等. 局部进展期直肠癌新辅助治疗研究进展. 中国普外基础与临床杂志, 2023, 30(7): 882-888.
14.	秦启元, 马腾辉, 蔡建, 等. 经括约肌间切除术治疗新辅助放化疗后低位直肠癌的近远期并发症研究. 中华外科杂志, 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.	吴登峰, 刘源, 田志强, 等. 机器人与腹腔镜辅助直肠癌根治术的手术疗效与预后对比. 中国肿瘤外科杂志, 2024, 16(1): 47-53.
18.	李干斌, 韩加刚, 王振军, 等. 新辅助放化疗治疗局部进展期直肠癌的远期疗效及预后因素分析. 临床外科杂志, 2021, 29(5): 422-427.
19.	韩元圣, 丁丽华. 腹腔镜低位直肠癌部分、次全和完全经括约肌间切除术式的肿瘤学结果及肛门功能比较. 中国医学创新, 2018, 15(35): 57-61.
20.	赵亚茹, 乔文波. 直肠癌新辅助放疗研究进展. 现代肿瘤医学, 2022, 30(19): 3614-3617.
21.	孙祺, 刘畅, 叶健乔, 等. 局部进展期中低位直肠癌单纯新辅助化疗与新辅助放化疗的疗效比较. 西安交通大学学报(医学版), 2024, 45(2): 278-283.
22.	邵丽华, 陈刚. 极限保肛之低位直肠癌经括约肌间切除术(ISR). 中国肿瘤外科杂志, 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.	刘军广, 陈贺凯, 汪欣, 等. 腹腔镜低位直肠癌经括约肌间切除术后吻合口漏的影响因素分析及预测模型构建. 中华外科杂志, 2021, 59(5): 332-337.
26.	伊建奎, 张立峰, 谭黄业, 等. 超低位直肠癌病人经括约肌间切除术后吻合口漏的危险因素分析. 腹部外科, 2023, 36(6): 463-467.
27.	齐恒铎, 刘洋, 张珍瑜, 等. 低位直肠癌经括约肌间切除术后早期并发症的危险因素分析及预测模型的构建. 中华普通外科杂志, 2022, 37(10): 743-748.
28.	应俊, 孙亚煌, 王安琪, 等. 腹腔镜极低位直肠癌经括约肌间切除术后吻合口漏的影响因素及列线图预测模型构建. 中华消化外科杂志, 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, 黄平. 低位直肠癌经括约肌间切除术的临床研究与应用现状. 结直肠肛门外科, 2020, 26(2): 238-242.
3. 尹周一, 王梦圆, 游伟程, 等. 2022美国癌症统计报告解读及中美癌症流行情况对比. 肿瘤综合治疗电子杂志, 2022, 8(2):54-63.
4. 李干斌, 韩加刚, 王振军, 等. 新辅助放化疗治疗局部进展期直肠癌疗效分析. 中国实用外科杂志, 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. 姚宏伟, 张忠涛. 低位直肠癌临床研究中值得关注的问题. 中国实用外科杂志, 2019, 39(7): 655-658.
7. 黄胜辉, 池畔, 林惠铭, 等. 腹腔镜与开放经腹括约肌间切除术治疗低位直肠癌的近期疗效比较. 中华胃肠外科杂志, 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. 刘素红, 杨小景, 沈华杰. 腹腔镜经括约肌间切除术在低位直肠癌患者中的应用效果. 癌症进展, 2023, 21(3): 320-323.
10. 沈晓明, 刘如钱, 鲍传庆. 腹腔镜下全直肠系膜切除术联合经肛管括约肌间切除术在超低位直肠癌保肛手术中的应用效果分析. 实用临床医药杂志, 2017, 21(17): 131-132.
11. 汪晓东, 刘健博, 李立. 数据库建设第六部分: 结直肠癌分期的标签与结构化. 中国普外基础与临床杂志, 2020, 27(7): 873-879.
12. 李立. 结直肠癌外科应用技术的规范与创新(十五). 中国普外基础与临床杂志, 2008, 15(3): 215-217.
13. 刘雨晴, 毛笑笑, 冉昕昕, 等. 局部进展期直肠癌新辅助治疗研究进展. 中国普外基础与临床杂志, 2023, 30(7): 882-888.
14. 秦启元, 马腾辉, 蔡建, 等. 经括约肌间切除术治疗新辅助放化疗后低位直肠癌的近远期并发症研究. 中华外科杂志, 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. 吴登峰, 刘源, 田志强, 等. 机器人与腹腔镜辅助直肠癌根治术的手术疗效与预后对比. 中国肿瘤外科杂志, 2024, 16(1): 47-53.
18. 李干斌, 韩加刚, 王振军, 等. 新辅助放化疗治疗局部进展期直肠癌的远期疗效及预后因素分析. 临床外科杂志, 2021, 29(5): 422-427.
19. 韩元圣, 丁丽华. 腹腔镜低位直肠癌部分、次全和完全经括约肌间切除术式的肿瘤学结果及肛门功能比较. 中国医学创新, 2018, 15(35): 57-61.
20. 赵亚茹, 乔文波. 直肠癌新辅助放疗研究进展. 现代肿瘤医学, 2022, 30(19): 3614-3617.
21. 孙祺, 刘畅, 叶健乔, 等. 局部进展期中低位直肠癌单纯新辅助化疗与新辅助放化疗的疗效比较. 西安交通大学学报(医学版), 2024, 45(2): 278-283.
22. 邵丽华, 陈刚. 极限保肛之低位直肠癌经括约肌间切除术(ISR). 中国肿瘤外科杂志, 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. 刘军广, 陈贺凯, 汪欣, 等. 腹腔镜低位直肠癌经括约肌间切除术后吻合口漏的影响因素分析及预测模型构建. 中华外科杂志, 2021, 59(5): 332-337.
26. 伊建奎, 张立峰, 谭黄业, 等. 超低位直肠癌病人经括约肌间切除术后吻合口漏的危险因素分析. 腹部外科, 2023, 36(6): 463-467.
27. 齐恒铎, 刘洋, 张珍瑜, 等. 低位直肠癌经括约肌间切除术后早期并发症的危险因素分析及预测模型的构建. 中华普通外科杂志, 2022, 37(10): 743-748.
28. 应俊, 孙亚煌, 王安琪, 等. 腹腔镜极低位直肠癌经括约肌间切除术后吻合口漏的影响因素及列线图预测模型构建. 中华消化外科杂志, 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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