完整的病理反应是否会增加直肠癌的术后发病风险?
Thomas K S Tiang1, Adrian S S Yeoh1, Bushra Othman2
1Colorectal Surgery, Austin Health, Heidelberg, Victoria, Australia.
概括
在用于直肠癌的新辅助化疗或放射治疗 (NCRT) 后达到病理完整反应 (pCR) 不会增加手术并发症. 这一发现对于接受全腹腔切除术 (TME) 的患者的管理至关重要.
科学领域:
- 在瘤学瘤学.
- 外科胃肠道外科手术
- 临床研究 临床研究
背景情况:
- 在新辅助治疗后,直肠癌的最佳管理仍在争论中.
- 在直肠癌的新辅助疗法后,临床完整反应是关键的预后指标.
研究的目的:
- 为了比较局部晚期直肠癌患者的手术发病率.
- 为了确定病理完整反应 (pCR) 是否影响新辅助化学放射治疗 (NCRT) 和全间隔切除 (TME) 后的并发症率.
主要方法:
- 使用双国结肠直肠癌审计数据库 (澳大利亚和新西兰) 进行回顾性队列研究.
- 包括在2007-2019年间接受NCRT和外科切除的局部晚期直肠癌患者.
- 在pCR和没有pCR的患者之间比较并发症率.
主要成果:
- 分析了4584名患者,11%的人实现了pCR.
- 带着瘤切除的全腹腔切除 (TME) 与没有瘤切除的TME相比,主要/小并发症的发生率较低.
- 在TME与解,pCR没有增加并发症;男性的性别,年龄,N阶段,和ASA得分≥3是重要的因素.
- pCR没有影响解管泄漏率;男性性别和手术间隔有影响.
结论:
- 病理完整反应 (pCR) 不会提高直肠癌患者的手术并发症率.
- 诸如男性性别,年龄,手术前的N阶段和ASA得分等因素影响了TME与瘤结合的并发症.
- 这项研究澄清了TME剖析的安全性,无论NCRT后的pCR状态如何.
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