The safety and efficacy of radical surgery after modified total neoadjuvant therapy for locally advanced rectal cancer
10.3760/cma.j.cn112152-20191128-00767
- VernacularTitle:局部晚期直肠癌行改良全程新辅助治疗后外科手术的安全性和有效性
- Author:
Lin ZHANG
1
;
Liang YU
;
Yunlong WU
;
Qingqing ZHANG
;
Shuohao SHEN
;
Dongdong LI
;
Hui FANG
;
Lin YANG
;
Haizeng ZHANG
Author Information
1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院结直肠外科 100021
- Keywords:
Rectal neoplasms;
Modified total neoadjuvant therapy;
Operative complication;
Radical surgery
- From:
Chinese Journal of Oncology
2020;42(6):501-506
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical-pathological data of patients with locally advanced rectal cancer who underwent modified total neoadjuvant therapy (TNT), and to evaluate the safety and efficacy of radical surgery after modified total neoadjuvant therapy.Methods:The clinical-pathological data of 30 locally advanced rectal cancer patients who underwent modified TNT (mTNT) followed by radical resection were retrospectively analyzed. The surgical procedure, postoperative complications, tumor regression grade, tumor downstaging and prognosis were analyzed.Results:The 30 patients included 24 males and 6 females with a median age of 55.5 years. All patients underwent radical surgery after neoadjuvant therapy, 14 patients received low anterior resection, 14 patients received abdominal perineal resection, and the other 2 patients received Hartmann procedure. All patients achieved R0 resection with a median operative time 220 minutes and the median intraoperative blood loss was 200 ml. The morbidity of postoperative complications was 20% (6/30), including dysuria in 2 patients, delayed healing of perineal incision in 2 patients, intestinal obstruction in 1 patient and pelvic hemorrhage in 1 patient. The median time to first flatus after surgery was 3 days and the median postoperative hospital stay was 8 days. Postoperative pathological results showed that 15 patients (50.0%) had severe tumor regression, including 4 patients (13.3%) achieved pathological complete response (pCR), 12 patients (40.0%) had moderate tumor regression, and 3 patients (10.0%) had minor tumor regression. Twenty patients had detailed pre-treatment clinical stage, and among those 20 patients, 15 patients (75.0%) and 13 patients (65.0%) achieved downstaging of tumor T stage and N stage, respectively. Only 2 patients appeared distant metastasis, and no patient had local recurrence.Conclusions:For locally advanced rectal cancer patients, mTNT doesn′t increase the morbidity of postoperative complication and is a safe and effective treatment strategy with satisfactory short-term result.
