• 福建醫(yī)科大學(xué)福總臨床醫(yī)學(xué)院 南京軍區(qū)福州總醫(yī)院普通外科(福州 350025);

目的 探討新輔助放化療聯(lián)合保肛手術(shù)治療局部進(jìn)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(lián)合保肛手術(shù)治療患者的臨床資料。 常規(guī)分割放療，總劑量40 Gy，每周5次，每次2 Gy。于第4周放療結(jié)束后開始行全身化療，1個(gè)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(jié)束后4周進(jìn)行手術(shù)。
結(jié)果 經(jīng)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(jié)陰轉(zhuǎn)率為58.8%（10/17）。術(shù)后無(wú)吻合口漏發(fā)生，發(fā)生肝轉(zhuǎn)移1例，局部復(fù)發(fā)1例； 88.2%（30/34）患者術(shù)后肛門功能良好。
結(jié)論 對(duì)局部進(jìn)展期直腸癌患者采用新輔助放化療，能使腫瘤分期降低； 聯(lián)合行保肛手術(shù)，不增加手術(shù)并發(fā)癥的發(fā)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(lián)合保肛手術(shù)34例分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(8): 824-827. doi: 復(fù)制

1. 涂小煌, 張?jiān)僦? 陳少全, 等. 全直腸系膜切除術(shù)安全遠(yuǎn)切端距離的臨床研究 [J]. 中國(guó)普通外科雜志， 2009； 18（11）: 11751179.
2. 涂小煌, 張?jiān)僦? 宋京翔, 等. 大口徑肛管預(yù)防直腸癌術(shù)后吻合口漏的對(duì)比研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009； 16（10）: 830833.
3. 范恩學(xué), 房學(xué)東, 孫海俠, 等. 直腸癌TME與非TME手術(shù)的臨床分析 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2009； 12（10）: 875878.
4. 劉征云, 田福年. 應(yīng)用TME技術(shù)治療中低位直腸癌的體會(huì)[J]. 中國(guó)普外基礎(chǔ)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(wèi)根, 章俊杰, 黃軍平. 中低位直腸癌新輔助治療的遠(yuǎn)期療效 [J]. 實(shí)用醫(yī)學(xué)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(wèi)中. 術(shù)前放化療對(duì)低位直腸癌患者細(xì)胞免疫功能及保肛的影響 [J]. 結(jié)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(lián)合治療局部進(jìn)展期低位直腸癌 [J]. 中國(guó)實(shí)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(jié)轉(zhuǎn)移相關(guān)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(jié)直腸癌的新輔助化療 [J]. 中國(guó)普外基礎(chǔ)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. 1. 涂小煌, 張?jiān)僦? 陳少全, 等. 全直腸系膜切除術(shù)安全遠(yuǎn)切端距離的臨床研究 [J]. 中國(guó)普通外科雜志， 2009； 18（11）: 11751179.
  2. 2. 涂小煌, 張?jiān)僦? 宋京翔, 等. 大口徑肛管預(yù)防直腸癌術(shù)后吻合口漏的對(duì)比研究 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009； 16（10）: 830833.
  3. 3. 范恩學(xué), 房學(xué)東, 孫海俠, 等. 直腸癌TME與非TME手術(shù)的臨床分析 [J]. 中國(guó)現(xiàn)代普通外科進(jìn)展, 2009； 12（10）: 875878.
  4. 4. 劉征云, 田福年. 應(yīng)用TME技術(shù)治療中低位直腸癌的體會(huì)[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008； 15（11）: 844845.
  5. 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. 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. 7. 章衛(wèi)根, 章俊杰, 黃軍平. 中低位直腸癌新輔助治療的遠(yuǎn)期療效 [J]. 實(shí)用醫(yī)學(xué)雜志, 2009; 25（11）: 18061807.
  8. 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. 9. 唐宗江, 郭云, 唐衛(wèi)中. 術(shù)前放化療對(duì)低位直腸癌患者細(xì)胞免疫功能及保肛的影響 [J]. 結(jié)直腸肛門外科, 2007； 13（3）: 150152.
  10. 10. 郁寶銘, 吳唯勤. 新輔助化放療與TME聯(lián)合治療局部進(jìn)展期低位直腸癌 [J]. 中國(guó)實(shí)用外科雜志, 2005； 25（5）: 270272.
  11. 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. 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. 13. 曾智帆, 丁培榮, 潘志忠, 等. 直腸癌新輔助治療后淋巴結(jié)轉(zhuǎn)移相關(guān)因素分析 [J]. 癌癥, 2009； 28（9）: 923927.
  14. 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. 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. 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. 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. 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. 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. 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. 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. 22. 顧晉, 詹天成, 姚云峰. 結(jié)直腸癌的新輔助化療 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007； 14(6): 628629.
  23. 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. 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. 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. 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. 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. 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. 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.