Objective To assess the long-term efficacy of local excision after neoadjuvant che-moradiotherapy (nCRT) for advanced rectal cancer. Methods Recurrence and survival data from 47 patients with advanced rectal cancer who underwent local excision were retrospectively analyzed. Results Among patients who received nCRT, 5-year overall survival was 48% and recurrence rate was 38%. Among patients who received local excision, postoperative bleeding occurred in 3 and infection around the rectum in 2. No patients died of causes related to operation. The recurrence was correlated with postoperative histopathologic stage (ypT stage), but not with preop-erative stage. Compared with patients with recurrence, the proportion of patients with ypT0 and ypT1 significantly increased in patients without recurrence (79. 3% vs 38. 9%). Compared with patients with ypT2 and ypT3, 5-year overall survival and progression-free survival were obviously improved in patients with ypT0 and ypT1. Among the 18 patients with recurrence, local recurrence occurred in 8, distant recurrence in 7 and mixed recurrence in 3. Moreover, recurrence was detected more than 2 years after surgery in 12 (66.7%) of the 18 patients. Conclusion In advanced rectal cancer, postoperative recurrence is correlated with the degree of tumor shrinkage and lymphatic and vascular involvement, but not with preoperative stage, CEA levels and differentiation degree. Postoperative overall survival and disease-free survival are associated with ypT stage. Long-term follow-up should be strengthened due to prolonged time to recurrence afterrnnCRT.%目的 评价进展期直肠癌经新辅助治疗后行局部切除的远期效果.方法 回顾分析47例行局部切除的进展期直肠癌患者临床病理资料,统计分析患者的复发及生存资料.结果 经新辅助治疗的患者的5年总生存48%,总复发率为38%.局部切除术后创面出血3例和直肠周围感染2例,无手术相关死亡.复发与新辅助治疗前的分期无关,而与新辅助治疗后的分期(ypT)有关.新辅助治疗后无复发组的ypT0和ypT1的患者比例(79.3%)较复发组高(38.9%),ypT0及ypT1患者实施局部切除的5年总生存OS及无进展生存DFS显著优于ypT2及ypT3患者.复发患者中,局部复发8例,远处复发7例,混合复发3例.66.7%(12/18例)的患者复发出现在2年以后.结论 对于进展期直肠癌,术后复发与新辅助治疗后的肿瘤的退缩程度、淋巴管与微血管累及相关,与新辅助治疗前分期、CEA水平及分化程度无关.术后总生存和无病生存期与新辅助治疗后分期有关.新辅助治疗后,复发的时限较未行新辅助治疗患者长,必须加强术后的随访,延长随访时间.
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