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首页> 外文期刊>Surgical Endoscopy >Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy.
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Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy.

机译：经肛门内窥镜显微手术治疗直肠癌：比较有无新辅助放疗的伤口并发症发生率。

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BACKGROUND: Neoadjuvant therapy for rectal cancer has led to improved tumor downstaging and higher complete pathologic response rates. At the same time, the introduction of transanal endoscopic microsurgery (TEM) technique has renewed interest in local excision of rectal cancer. There has been concern that radiation may make the more radical local excision with TEM unsuitable. Our study compared morbidity rates and wound complication rates for patients undergoing TEM and local excision with and without neoadjuvant radiation to determine whether this could be accomplished safely. METHODS: Data for all patients undergoing TEM are prospectively entered into a database. This database was queried for patients with rectal cancer undergoing TEM from November 1997 to June 2007. Of 64 patients identified, 2 were excluded because of previous radiation to the pelvis. RESULTS: The study enrolled 62 patients with a final pathologic diagnosis of rectal cancer: 43 treated using neoadjuvant therapy with radiation (XRT) and 19 patients treated with TEM alone. The patients in the XRT group were 67 years of age (range, 29-86 years) and included 13 women. The patients in the non-XRT group were 66 years of age (range, 40-89 years) and included 8 women. Neither group had any mortalities. The overall morbidity rate was 33% for the XRT group and 5.3% for the non-XRT group, and this difference was statistically significant (p < 0.05). The wound complication rates were 25.6% for the XRT group (11 patients) and 0% for the non-XRT group (p = 0.015). Nine patients in the XRT group (82%) had minor wound separations, and two patients (18%) had major wound separation. Ten patients with wound separations were treated as outpatients and administered long-term oral antibiotics. One patient required additional surgery (diverting stoma). CONCLUSIONS: Not unexpectedly, the wound complication rate was higher in the XRT group. However, 82% of those wounds were minor, and 91% were treated without any additional surgery or intervention. Although a significant concern, wound complications do not prohibit TEM treatment after neoadjuvant treatment.
机译：背景：针对直肠癌的新辅助疗法已导致改善的肿瘤分期和更高的完全病理反应率。同时，经肛门内窥镜显微术（TEM）技术的引入引起了人们对直肠癌局部切除术的兴趣。有人担心，放射线可能会使采用TEM进行更彻底的局部切除不适合。我们的研究比较了接受TEM和不接受新辅助放疗的TEM和局部切除患者的发病率和伤口并发症发生率，以确定是否可以安全地完成。方法：前瞻性地将所有接受TEM的患者的数据输入数据库。该数据库用于查询1997年11月至2007年6月接受TEM的直肠癌患者。在确定的64例患者中，有2例由于先前接受过骨盆放射而被排除在外。结果：该研究招募了62例最终诊断为直肠癌的患者：43例接受新辅助放射治疗（XRT）的患者和19例单独接受TEM的患者。 XRT组的患者年龄为67岁（范围29-86岁），包括13名女性。非XRT组的患者年龄为66岁（范围40-89岁），包括8名女性。两组都没有死亡。 XRT组的总发病率为33％，非XRT组的总发病率为5.3％，差异具有统计学意义（p <0.05）。 XRT组（11例）的伤口并发症发生率为25.6％，非XRT组为0％（p = 0.015）。 XRT组中有9例（82％）出现了轻微的伤口分离，而2例（18％）出现了严重的伤口分离。十名伤口分离的患者被视为门诊患者，并给予长期口服抗生素治疗。一名患者需要额外的手术（转移造口）。结论：XRT组伤口并发症发生率较高，这并不出乎意料。但是，这些伤口中有82％为轻微伤口，而91％的伤口未经任何额外的手术或干预就得到了治疗。尽管引起了广泛关注，但伤口并发症并不能阻止新辅助治疗后的TEM治疗。

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