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在新辅助疗法和辐射增强后,因器官保存失败而进行节节约手术:一名外科医生的观点

Sanjay Singh¹, Abdeali Saif Arif Kaderi¹, Mufaddal Kazi¹

¹Department of Colorectal and Robotic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernest Borges Rd, Parel, Mumbai, Maharashtra, 400012, India.

BMC gastroenterology

|May 19, 2025

概括

在低直肠癌中,支臂疗法增强放射疗法 (BoRT) 显著恶化了内切除 (ISR) 和静脉逆转后的功能结果. 接受BoRT治疗的患者出现较高的低前切除综合征和便失禁率.

科学领域:

在瘤学瘤学.
外科胃肠道外科手术
辐射瘤学辐射瘤学

背景情况:

低直肠癌的治疗旨在平衡瘤控制与功能结果.
器官保存是关键的目标,与brachytherapy增强放射疗法 (BoRT) 作为总的新辅助疗法的替代品.
需要澄清BoRT对神经关切除 (ISR) 后神经关切除和胃口逆转后神经关功能的影响.

研究的目的:

为了比较低直肠癌患者的功能结果,这些患者接受了ISR,并没有手术前的支臂疗法或手术前的支臂疗法增强放射疗法 (BoRT).
为了评估BoRT对关节功能的影响,在静脉门倒置后.

主要方法:

在2013-2021年期间治疗的145名患者的回顾性分析.
倾向性得分匹配 (1:4比) 与接受手术前BoRT的18名患者与127名对照进行了比较.
使用低前切除综合征 (LARS) 评分,韦克斯纳评分和基文等级来评估胃逆转后六个月的功能结局.

主要成果:

接受BoRT治疗的患者表现出明显更差的功能结果.
在BoRT组中,中位数LARS得分为36 (非常高),而在无增强组中为10 (p<0.001).
在BoRT组中,Wexner评分的中位数为17分,而在无增强组中为8分 (p<0.001).

结论:

在手术前的支臂疗法增强放射治疗 (BoRT) 对低直肠癌的内切除 (ISR) 后的功能结果产生负面影响.
在开始BoRT之前,对潜在的功能缺陷进行全面的患者咨询至关重要.
应讨论替代性手术策略,如果没有达到最佳的结果后brachytherapy.

关键词:

支臂疗法可以促进放射治疗.接触X射线支臂疗法接触X射线支臂疗法脊髓间切除 - - 脊髓间切除.挽救手术是一种救援手术.护理神经的保护

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