FAP患者全结肠切除术与直结肠切除术的长期生存率:一项基于登记的观察性队列研究

I. Ardoino, S. Signoroni, Enzo Malvicini, M. T. Ricci, E. Biganzoli, L. Bertario, S. Occhionorelli, M. Vitellaro
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引用次数: 16

摘要

背景:家族性腺瘤性息肉病(FAP)患者的最佳手术选择仍有争议。目前还没有前瞻性试验来评估推荐手术的利弊:全结肠切除术(回直肠吻合术[IRA])和恢复性直结肠切除术(回肠袋-肛门吻合术[IPAA])。本研究的目的是为FAP患者的精准手术提供依据。方法:我们对在意大利米兰的一个专用数据库中登记的接受手术的FAP患者进行了回顾性研究。采用Cox回归模型研究与手术入路相关的20年生存率和预后因素。结果:1947年至2015年间共有925例患者接受了手术:340例(36.8%)IPAA, 585例(63.2%)IRA。28.6%的患者在手术中被诊断出结直肠癌(CRC), 88%的患者被鉴定出致病性APC变异。在平均129个月的随访期间,150名患者死亡。IRA组的生存率显著高于IPAA组:0.82 vs 0.75(风险比[HR] 0.6, 95%可信区间[CI] 0.42-0.84)。多变量回归模型调整倾向得分显示类似的差异,虽然不再显著。多变量分析显示,结直肠癌(HR 4.68, 95% CI 3.04-7.20)和手术年龄(HR 1.03, 95% CI 1.02-1.06)是独立危险因素。在没有癌症的患者中,缩短生存期的主要危险因素是年龄较大(HR 1.06, 95% CI 1.04-1.09)。结论:该研究证实了IRA和IPAA手术入路的良好长期效果,表明最佳手术选择可能是个体化和临床定制的入路,最好是在年轻时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term survival between total colectomy versus proctocolectomy in patients with FAP: a registry-based, observational cohort study
Background: The best surgical choice for patients with familial adenomatous polyposis (FAP) is still debated. No prospective trials have been carried out to evaluate the pros and cons of the recommended procedures: total colectomy (ileorectal anastomosis [IRA]) vs restorative proctocolectomy (ileal pouch–anal anastomosis [IPAA]). The aim of this study was to provide a basis for tailored precision surgery in patients with FAP. Methods: We conducted a retrospective review of patients with FAP who underwent surgery and were registered in a dedicated database in Milan, Italy. Twenty-year survival related to surgical approach and prognostic factors were investigated using a Cox regression model. Results: A total of 925 patients underwent surgery between 1947 and 2015: 340 (36.8%) IPAA and 585 (63.2%) IRA. Colorectal cancer (CRC) at surgery was diagnosed in 28.6% of patients and a pathogenic APC variant was identified in 88%. During a median follow-up of 129 months, 150 patients died. The survival probability was significantly higher in the IRA than the IPAA group: 0.82 vs 0.75 (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.42–0.84). Multivariable regression modeling adjusted for propensity scores showed a similar difference, although no longer significant. Multivariable analysis indicated as independent risk factors CRC (HR 4.68, 95% CI 3.04–7.20) and age at surgery (HR 1.03, 95% CI 1.02–1.06). Among patients without cancer, the main risk factor for shorter survival was older age (HR 1.06, 95% CI 1.04–1.09). Conclusion: The study confirms excellent long-term results of surgical approaches with IRA and IPAA, suggesting that the best surgical choice may be an individually and clinically tailored approach, preferably at a young age.
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