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首页> 外文期刊>Surgical Endoscopy >Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation.
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Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation.

机译：新辅助放化疗后，直肠癌与局部切除术和经肛门内镜显微手术相结合。

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BACKGROUND: Neoadjuvant therapies have significantly improved local control and survival of patients with rectal cancer. Nevertheless, although a complete pathologic response can be achieved in 30% of cases, a transabdominal surgical resection is always required. This study aimed, for the first time, to test in the literature the feasibility of local excision combined with transanal endoscopic microsurgery (TEM) as a surgical option for patients treated with neoadjuvant chemoradiation. METHODS: Between July 1997 and December 2002, 30 patients with rectal cancer affected by an extraperitoneal tumor entered a protocol consisting of neoadjuvant chemoradiation followed by surgery. The surgical treatment, consisting of open surgery, local excision, or TEM, was planned according to the patient's clinical response after chemoradiation and distance from the anal verge. RESULTS: A significant clinical downstaging was observed in eight patients. Five of these patients underwent TEM, and three had local excision.Consequently, open surgery was performed for 22 patients. Histology showed six cases of complete pathologic response: three in the open surgery group and three in the transanal excision group. After a mean follow-up period of 47 months, the disease-free survival rate was 77% in the open surgery group and 100% in TEM or local excision group. CONCLUSIONS: The findings suggest the complementary feasibility of TEM and local excision after neoadjuvant chemoradiation. However, randomized trials are needed to confirm the oncologic safety of this approach.
机译：背景：新辅助疗法已大大改善了直肠癌患者的局部控制和生存率。尽管如此，尽管在30％的病例中可以实现完全的病理反应，但始终需要进行腹部手术切除。这项研究的目的是首次在文献中测试局部切除结合经肛门内镜显微手术（TEM）作为新辅助化学放疗患者的手术选择的可行性。方法：1997年7月至2002年12月，共有30例受腹膜外肿瘤影响的直肠癌患者接受了新辅助放化疗和手术治疗。根据患者放化疗后的临床反应和距肛门边缘的距离，计划手术包括开放手术，局部切除或TEM。结果：在八名患者中观察到显着的临床分期。这些患者中有5例接受了TEM，另外3例进行了局部切除，因此对22例患者进行了开放手术。组织学显示完全病理反应6例：开放手术组3例，经肛门切除组3例。平均随访47个月后，开放手术组的无病生存率为77％，而TEM或局部切除组的无病生存率为100％。结论：这些发现提示新辅助化学放疗后TEM和局部切除的互补可行性。但是，需要随机试验来确认这种方法的肿瘤学安全性。

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