直腸癌新輔助治療聯合保肛手術34例分析_《中國普外基礎與臨床雜志》

作者：

薛小軍 , 陳少全 , 涂小煌 , 宋京翔

福建醫科大學福總臨床醫學院南京軍區福州總醫院普通外科(福州 350025);

關鍵詞：

新輔助放化療低位直腸癌保肛手術敏感性

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目的探討新輔助放化療聯合保肛手術治療局部進展期直腸癌的安全性。
方法回顧性分析2007年6月至2009年6月期間我科收治的34例T3、T4期低位直腸癌采用新輔助放化療聯合保肛手術治療患者的臨床資料。常規分割放療，總劑量40 Gy，每周5次，每次2 Gy。于第4周放療結束后開始行全身化療，1個療程，方案為奧沙利鉑(150 mg/d1)、亞葉酸鈣(100 mg/d1~3)加5FU(750 mg/d1~3)。于新輔助治療結束后4周進行手術。
結果經新輔助治療后，腫瘤直徑平均縮小41.2%，67.6%（23/34）的病例T分期下降，淋巴結陰轉率為58.8%（10/17）。術后無吻合口漏發生，發生肝轉移1例，局部復發1例； 88.2%（30/34）患者術后肛門功能良好。
結論對局部進展期直腸癌患者采用新輔助放化療，能使腫瘤分期降低；聯合行保肛手術，不增加手術并發癥的發生率，安全、有效。

引用本文： 薛小軍,陳少全,涂小煌,宋京翔. 直腸癌新輔助治療聯合保肛手術34例分析. 中國普外基礎與臨床雜志, 2010, 17(8): 824-827. doi: 復制

1.	涂小煌, 張再重, 陳少全, 等. 全直腸系膜切除術安全遠切端距離的臨床研究 [J]. 中國普通外科雜志， 2009； 18（11）: 11751179.
2.	涂小煌, 張再重, 宋京翔, 等. 大口徑肛管預防直腸癌術后吻合口漏的對比研究 [J]. 中國普外基礎與臨床雜志, 2009； 16（10）: 830833.
3.	范恩學, 房學東, 孫海俠, 等. 直腸癌TME與非TME手術的臨床分析 [J]. 中國現代普通外科進展, 2009； 12（10）: 875878.
4.	劉征云, 田福年. 應用TME技術治療中低位直腸癌的體會[J]. 中國普外基礎與臨床雜志, 2008； 15（11）: 844845.
5.	den Dulk M, Collette L, van de Velde CJ, et al. Quality of surgery in T34 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Restult from EORTC trial 22921[J]. Eur J Cancer, 2007； 43（12）: 18211828.
6.	Ulrich A, Weitz J, Slodczyk M, et al. Neoadjuvant treatment does not influence perioperative outcome in rectal cancer surgery[J]. Int J Radiat Oncol Biol Phys, 2009； 75（1）: 129136.
7.	章衛根, 章俊杰, 黃軍平. 中低位直腸癌新輔助治療的遠期療效 [J]. 實用醫學雜志, 2009; 25（11）: 18061807.
8.	Twu CM, Wang HM, Chen JB, et al. Neoadjuvant concurrent chemoradiotherapy in treating locally advanced rectal cancer[J]. J Chin Med Assoc, 2009； 72（4）: 179182.
9.	唐宗江, 郭云, 唐衛中. 術前放化療對低位直腸癌患者細胞免疫功能及保肛的影響 [J]. 結直腸肛門外科, 2007； 13（3）: 150152.
10.	郁寶銘, 吳唯勤. 新輔助化放療與TME聯合治療局部進展期低位直腸癌 [J]. 中國實用外科雜志, 2005； 25（5）: 270272.
11.	Beddy D, Hyland JM, Winter DC, et al. A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy [J]. Ann Surg Oncol, 2008； 15（12）: 34713477.
12.	Caricato M, Ausania F, De Dominicis E, et al. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer[J]. Eur J Surg Oncol, 2007； 33（6）: 724728.
13.	曾智帆, 丁培榮, 潘志忠, 等. 直腸癌新輔助治療后淋巴結轉移相關因素分析 [J]. 癌癥, 2009； 28（9）: 923927.
14.	Ciccocioppo A, Stephens JH, Hewett PJ, et al. Complete pathologic response after preoperative rectal cancer chemoradiotherapy[J]. ANZ J Surg, 2009； 79(6): 481484.
15.	Castaldo ET, Parikh AA, Pinson CW, et al. Improvement of survival with response to neoadjuvant radiation therapy for rectal cancer[J]. Arch Surg, 2009； 144(2): 129135.
16.	郁寶銘, 張敏, 吳唯勤. 腫瘤降期在低位直腸癌新輔助治療中的意義 [J]. 世界華人消化雜志, 2007； 15（32）: 34463450.
17.	Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves diseasefree survival in patients with carcinoma of the rectum: NSABP R03[J]. J Clin Oncol, 2009； 27（31）: 51245130.
18.	Dhadda AS, Zaitoun AM, Bessell EM. Regression of rectal cancer with radiotherapy with or without concurrent capecitabine—optimising the timing of surgical resection[J]. Clin Oncol (R Coll Radiol), 2009； 21（1）: 2331.
19.	HabrGama A, Perez RO, Sabbaga J, et al. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period[J]. Dis Colon Rectum, 2009； 52(12): 19271934.
20.	Sato T, Kokuba Y, Koizumi W, et al. Phase Ⅰ trial of neoadjuvant preoperative chemotherapy with S1 and irinotecan plus radiation in patients with locally advanced rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 69(5): 14421447.
21.	Kim NK, Kim YW, Min BS, et al. Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer [J]. World J Surg, 2009； 33（8）: 17411749.
22.	顧晉, 詹天成, 姚云峰. 結直腸癌的新輔助化療 [J]. 中國普外基礎與臨床雜志, 2007； 14(6): 628629.
23.	HoPunCheung A, Assenat E, Thezenas S, et al. Cyclin D1 gene G870A polymorphism predicts response to neoadjuvant radiotherapy and prognosis in rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 68(4): 10941101.
24.	Lin LC, Lee HH, Hwang WS, et al. p53 and p27 as predictors of clinical outcome for rectalcancer patients receiving neoadjuvant therapy[J]. Surg Oncol, 2006； 15(4): 211216.
25.	Yasuda H, Tanaka K, Saigusa S, et al. Elevated CD133, but not VEGF or EGFR, as a predictive marker of distant recurrence after preoperative chemoradiotherapy in rectal cancer[J]. Oncol Rep, 2009； 22（4）: 709717.
26.	Perez RO, So Julio GP, HabrGama A, et al. The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant chemoradiotherapy for distal rectal cancer[J]. Dis Colon Rectum, 2009； 52（6）: 11371143.
27.	Moreno García V, Cejas P, Blanco Codesido M, et al. Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy[J]. Int J Colorectal Dis, 2009； 24（7）: 741748.
28.	Baik SH, Kim NK, Lee KY, et al. Analysis of anal sphincter preservation rate according to tumor level and neoadjuvant chemoradiotherapy inrectal cancer patients[J]. J Gastrointest Surg, 2008； 12(1): 176182.
29.	Pucciarelli S, Toppan P, Friso ML, et al. Complete pathologic response follow preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome[J]. Dis Colon Rectum, 2004； 47(11): 17981807.

1. 涂小煌, 張再重, 陳少全, 等. 全直腸系膜切除術安全遠切端距離的臨床研究 [J]. 中國普通外科雜志， 2009； 18（11）: 11751179.
2. 涂小煌, 張再重, 宋京翔, 等. 大口徑肛管預防直腸癌術后吻合口漏的對比研究 [J]. 中國普外基礎與臨床雜志, 2009； 16（10）: 830833.
3. 范恩學, 房學東, 孫海俠, 等. 直腸癌TME與非TME手術的臨床分析 [J]. 中國現代普通外科進展, 2009； 12（10）: 875878.
4. 劉征云, 田福年. 應用TME技術治療中低位直腸癌的體會[J]. 中國普外基礎與臨床雜志, 2008； 15（11）: 844845.
5. den Dulk M, Collette L, van de Velde CJ, et al. Quality of surgery in T34 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Restult from EORTC trial 22921[J]. Eur J Cancer, 2007； 43（12）: 18211828.
6. Ulrich A, Weitz J, Slodczyk M, et al. Neoadjuvant treatment does not influence perioperative outcome in rectal cancer surgery[J]. Int J Radiat Oncol Biol Phys, 2009； 75（1）: 129136.
7. 章衛根, 章俊杰, 黃軍平. 中低位直腸癌新輔助治療的遠期療效 [J]. 實用醫學雜志, 2009; 25（11）: 18061807.
8. Twu CM, Wang HM, Chen JB, et al. Neoadjuvant concurrent chemoradiotherapy in treating locally advanced rectal cancer[J]. J Chin Med Assoc, 2009； 72（4）: 179182.
9. 唐宗江, 郭云, 唐衛中. 術前放化療對低位直腸癌患者細胞免疫功能及保肛的影響 [J]. 結直腸肛門外科, 2007； 13（3）: 150152.
10. 郁寶銘, 吳唯勤. 新輔助化放療與TME聯合治療局部進展期低位直腸癌 [J]. 中國實用外科雜志, 2005； 25（5）: 270272.
11. Beddy D, Hyland JM, Winter DC, et al. A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy [J]. Ann Surg Oncol, 2008； 15（12）: 34713477.
12. Caricato M, Ausania F, De Dominicis E, et al. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer[J]. Eur J Surg Oncol, 2007； 33（6）: 724728.
13. 曾智帆, 丁培榮, 潘志忠, 等. 直腸癌新輔助治療后淋巴結轉移相關因素分析 [J]. 癌癥, 2009； 28（9）: 923927.
14. Ciccocioppo A, Stephens JH, Hewett PJ, et al. Complete pathologic response after preoperative rectal cancer chemoradiotherapy[J]. ANZ J Surg, 2009； 79(6): 481484.
15. Castaldo ET, Parikh AA, Pinson CW, et al. Improvement of survival with response to neoadjuvant radiation therapy for rectal cancer[J]. Arch Surg, 2009； 144(2): 129135.
16. 郁寶銘, 張敏, 吳唯勤. 腫瘤降期在低位直腸癌新輔助治療中的意義 [J]. 世界華人消化雜志, 2007； 15（32）: 34463450.
17. Roh MS, Colangelo LH, O’Connell MJ, et al. Preoperative multimodality therapy improves diseasefree survival in patients with carcinoma of the rectum: NSABP R03[J]. J Clin Oncol, 2009； 27（31）: 51245130.
18. Dhadda AS, Zaitoun AM, Bessell EM. Regression of rectal cancer with radiotherapy with or without concurrent capecitabine—optimising the timing of surgical resection[J]. Clin Oncol (R Coll Radiol), 2009； 21（1）: 2331.
19. HabrGama A, Perez RO, Sabbaga J, et al. Increasing the rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a prospective study using additional chemotherapy during the resting period[J]. Dis Colon Rectum, 2009； 52(12): 19271934.
20. Sato T, Kokuba Y, Koizumi W, et al. Phase Ⅰ trial of neoadjuvant preoperative chemotherapy with S1 and irinotecan plus radiation in patients with locally advanced rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 69(5): 14421447.
21. Kim NK, Kim YW, Min BS, et al. Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer [J]. World J Surg, 2009； 33（8）: 17411749.
22. 顧晉, 詹天成, 姚云峰. 結直腸癌的新輔助化療 [J]. 中國普外基礎與臨床雜志, 2007； 14(6): 628629.
23. HoPunCheung A, Assenat E, Thezenas S, et al. Cyclin D1 gene G870A polymorphism predicts response to neoadjuvant radiotherapy and prognosis in rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2007； 68(4): 10941101.
24. Lin LC, Lee HH, Hwang WS, et al. p53 and p27 as predictors of clinical outcome for rectalcancer patients receiving neoadjuvant therapy[J]. Surg Oncol, 2006； 15(4): 211216.
25. Yasuda H, Tanaka K, Saigusa S, et al. Elevated CD133, but not VEGF or EGFR, as a predictive marker of distant recurrence after preoperative chemoradiotherapy in rectal cancer[J]. Oncol Rep, 2009； 22（4）: 709717.
26. Perez RO, So Julio GP, HabrGama A, et al. The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant chemoradiotherapy for distal rectal cancer[J]. Dis Colon Rectum, 2009； 52（6）: 11371143.
27. Moreno García V, Cejas P, Blanco Codesido M, et al. Prognostic value of carcinoembryonic antigen level in rectal cancer treated with neoadjuvant chemoradiotherapy[J]. Int J Colorectal Dis, 2009； 24（7）: 741748.
28. Baik SH, Kim NK, Lee KY, et al. Analysis of anal sphincter preservation rate according to tumor level and neoadjuvant chemoradiotherapy inrectal cancer patients[J]. J Gastrointest Surg, 2008； 12(1): 176182.
29. Pucciarelli S, Toppan P, Friso ML, et al. Complete pathologic response follow preoperative chemoradiation therapy for middle to lower rectal cancer is not a prognostic factor for a better outcome[J]. Dis Colon Rectum, 2004； 47(11): 17981807.

《中國普外基礎與臨床雜志》

直腸癌新輔助治療聯合保肛手術34例分析

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《中國普外基礎與臨床雜志》

直腸癌新輔助治療聯合保肛手術34例分析

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