Effect of Subsequent Surgical Treatment for Complete Response Cases after Neoadjuvant Chemoradiotherapy of Low Locally Advanced Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 田君 ^1,2 , 姚学权 ¹ , 曹勤洪 ¹ ,  陈彻 ¹ , 朱旭升 ¹ , 许哲 ¹ , 李为苏 ¹ , 刘福坤 ¹

1. ;
2. ;

Corresponding author：

陈彻, Email: 9429038@qq.com

Keywords：

直肠癌; 新辅助放化疗; 病理完全缓解; 癌胚抗原; 全直肠系膜切除术

DOI：

10.7507/1007-9424.20140179

Video：

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目的探讨低位局部进展期直肠癌新辅助放化疗后完全缓解病例的进一步治疗方案及效果。方法回顾性分析江苏省中医院肿瘤外科2008年1月至2010年5月期间行新辅助放化疗后初步判断达到病理完全缓解（pCR）的14例低位局部进展期直肠癌患者的临床资料。结果 14例患者中接受手术者10例，术后真正达到pCR者5例；术后2例复发或转移，其中死亡1例，1例带瘤生存，余8例患者均无瘤生存。未行手术的4例患者中，有3例复发或转移，其中2例死亡，1例带瘤生存；余1例无瘤生存。4例未行手术病例中CEA水平正常者（<5 μg/L）2例（1例复发或转移），CEA升高的2例均发生转移；10例手术病例中CEA水平正常者6例（均无瘤生存，4例真正达到pCR），升高者4例（1例真正达到pCR，2例复发或转移）。结论接受新辅助放化疗后初步判断达到pCR的病例，尤其是CEA值高于正常者，应接受规范的全直肠系膜切除（TME）手术以达到根治的目的。

Citation： 田君, 姚学权, 曹勤洪, 陈彻, 朱旭升, 许哲, 李为苏, 刘福坤. Effect of Subsequent Surgical Treatment for Complete Response Cases after Neoadjuvant Chemoradiotherapy of Low Locally Advanced Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 754-756. doi: 10.7507/1007-9424.20140179 Copy

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14.	孔杰,杨忠全,邬显琨,等.低位直肠癌保肛手术40例临床分析[J].河北医学, 2007, 13(7):834-836.
15.	李昂,曹锋,方育,等.术前放化疗结合全直肠系膜切除在低位进展期直肠癌治疗中的应用[J].中国普外基础与临床杂志, 2012, 19(9):971-974.
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1. Bosset JF, Collette L, Calais G, et al.Chemotherapy with preoperative radiotherapy in rectal cancer[J].N Engl J Med, 2006, 355(11):1114-1123.
2. Greto D, Paiar F, Saieva C, et al.Neoadjuvant oxaliplatin and 5-fluorouracil with concurrent radiotherapy in patients with locally advanced rectal cancer:a single-institution experience[J].Radiol Med, 2013, 118(4):570-582.
3. Improved survival with preoperative radiotherapy in resectable rectal cancer.Swedish Rectal Cancer Trial[J].N Engl J Med, 1997, 336(14):980-987.
4. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al.Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer[J].N Engl J Med, 2001, 345(9):638-646.
5. Colorectal Cancer Collaborative Group.Adjuvant radiotherapy for rectal cancer:a systematic overview of 8507 patients from 22 randomised trials[J].Lancet, 2001, 358(9290):1291-1304.
6. 李世正,单吉贤,马振海,等.直肠癌根治术前辅助放射治疗随机研究的meta分析[J].中国实用外科杂志, 2006, 26(8):598-601.
7. Kuriu Y, Kokuba Y, Murayama Y, et al.Neoadjuvant chemoradiotherapy for locally advanced rectal cancer[J].Gan To Kagaku Ryoho, 2012, 39(12):1951-1953.
8. Habr-Gama A, Perez RO, Nadalin W, et al.Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy:long-term results[J].Ann Surg, 2004, 240(4):711-717.
9. Maas M, Nelemans PJ, Valentini V, et al.Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer:a pooled analysis of individual patient data[J].Lancet Oncol, 2010, 11(9):835-844.
10. Nakagawa WT, Rossi BM, de O Ferreira F, et al.Chemoradiation instead of surgery to treat mid and low rectal tumors:is it safe?[J].Ann Surg Oncol, 2002, 9(6):568-573.
11. Kuo LJ, Liu MC, Jian JJ, et al.Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy?[J].Ann Surg Oncol, 2007, 14(10):2766-2772.
12. Heald RJ, Husband EM, Ryall RD.The mesorectum in rectal cancer surgery-the clue to pelvic recurrence?[J].Br J Surg, 1982, 69(10):613-616.
13. Göhl J, Hohenberger W, Merkel S.Lymph node dissection in rectal carcinoma:TME and what else?[J].Onkologie, 2009, 32(1-2):57-61.
14. 孔杰,杨忠全,邬显琨,等.低位直肠癌保肛手术40例临床分析[J].河北医学, 2007, 13(7):834-836.
15. 李昂,曹锋,方育,等.术前放化疗结合全直肠系膜切除在低位进展期直肠癌治疗中的应用[J].中国普外基础与临床杂志, 2012, 19(9):971-974.
16. Park YA, Sohn SK, Seong J, et al.Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer[J].J Surg Oncol, 2006, 93(2):145-150.
17. Yoon SM, Kim DY, Kim TH, et al.Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys, 2007, 69(4):1167-1172.
18. 陈纲,李世拥,于波,等.直肠癌术前放化疗反应的相关因素分析[J].中国普外基础与临床杂志, 2014, 21(2):177-181.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Subsequent Surgical Treatment for Complete Response Cases after Neoadjuvant Chemoradiotherapy of Low Locally Advanced Rectal Cancer

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