直肠癌手术的全直肠系膜切除质量影响局部复发率,但不影响远处复发和生存:基于人群的队列研究。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae071
Åsa Collin, Cecilia Dahlbäck, Joakim Folkesson, Pamela Buchwald
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引用次数: 0

摘要

背景:直肠癌手术中全直肠间膜切除标本的质量由三级(直肠间膜、直肠内膜和固有肌)评估。本研究旨在分析总直肠间质切除等级对生存率的预后影响,并在基于人群的环境中确定直肠内和固有肌切除的风险因素:方法:分析瑞典结直肠癌登记处2015-2019年确诊的所有直肠癌I-III期(距肛缘≤10厘米)患者,这些患者均接受了全直肠系膜切除术。对临床、手术和病理数据进行了检索,并对以下主要结果进行了分析:局部和远处复发、总生存率和相对生存率;次要结果是全直肠系膜切除术分级(直肠内切除或肌固有层切除)的风险因素。值得注意的是,术后死亡<30天或90天内复发是生存率和复发分析的排除标准。复发分析还排除了随访不足 3 年的无复发患者和缺乏复发数据的患者:总体而言,在研究期间接受治疗的 7979 例患者中,有 1499 例患者符合复发分析条件,2441 例患者符合生存分析条件,2476 例患者符合风险因素分析条件,其中 75% 为直肠中膜分级,17% 为直肠内分级,8% 为固有肌分级。中位随访生存期为 42(1-77)个月。在多变量分析中,最差的总直肠系膜切除分级(肌固有层切除)是局部复发的独立风险因素(HR 2.73,95% c.i.1.07-7.0,P = 0.036)。全直肠系膜切除等级对远处复发或生存率没有影响。女性性别、肿瘤级别 结论:肌层切除会增加局部复发的风险,但似乎不会影响远处复发或生存。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Total mesorectal excision quality in rectal cancer surgery affects local recurrence rate but not distant recurrence and survival: population-based cohort study.

Background: The quality of the total mesorectal excision specimen in rectal cancer surgery is assessed with a three-tier grade (mesorectal, intramesorectal and muscularis propria). This study aimed to analyse the prognostic impact of the total mesorectal excision grade on survival, and to identify risk factors for intramesorectal and muscularis propria resection in a population-based setting.

Methods: All patients in the Swedish Colorectal Cancer Registry with rectal cancer stage I-III ≤ 10 cm from the anal verge, diagnosed 2015-2019, undergoing total mesorectal excision were analysed. Clinical, surgical and pathological data were retrieved and analysed for the following primary outcomes: local and distant recurrence and overall and relative survival; secondary outcomes were risk factors for total mesorectal excision grading (intramesorectal or muscularis propria resection). Of note, postoperative death < 30 days or recurrence within 90 days were exclusion criteria for survival and recurrence analysis. Recurrence-free patients with less than 3 years follow-up, and patients lacking data regarding recurrence, were also excluded from recurrence analyses.

Results: Overall, of 7979 patients treated during the study interval, 1499 patients were eligible for recurrence, 2441 patients for survival and 2476 patients for risk-factor analyses, of which 75% were graded mesorectal, 17% intramesorectal and 8% muscularis propria. Median follow-up for survival was 42 (1-77) months. The worst total mesorectal excision grading (muscularis propria resection) was an independent risk factor for local recurrence in multivariable analysis (HR 2.73, 95% c.i. 1.07 to 7.0, P = 0.036). Total mesorectal excision grade had no impact on distant recurrence or survival. Female sex, tumour level <5 cm, abdominoperineal resection, minimally invasive surgery (laparoscopic and robotic), high blood loss, long duration of surgery and intraoperative perforation were independent risk factors for worse total mesorectal excision grading (intramesorectal and/or muscularis propria resection) in multivariable analyses.

Conclusion: Muscularis propria resection increases the risk of local recurrence but does not seem to affect distant recurrence or survival.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
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144
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